Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

An experimental study to evaluate the effect of planned teaching on self-medication practices of older… Goodman, Gertrude Warkentin 1972

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1972_A5_7 G66.pdf [ 3.8MB ]
Metadata
JSON: 831-1.0101666.json
JSON-LD: 831-1.0101666-ld.json
RDF/XML (Pretty): 831-1.0101666-rdf.xml
RDF/JSON: 831-1.0101666-rdf.json
Turtle: 831-1.0101666-turtle.txt
N-Triples: 831-1.0101666-rdf-ntriples.txt
Original Record: 831-1.0101666-source.json
Full Text
831-1.0101666-fulltext.txt
Citation
831-1.0101666.ris

Full Text

AN E X P E R I M E N T A L  STUDY  TO E V A L U A T E  THE E F F E C T  P L A N N E D T E A C H I N G ON S E L F - M E D I C A T I O N OF OLDER AMBULATORY C A R D I A C  OF  PRACTICES  PATIENTS  by  GERTRUDE B.S.N.,  A  WARKENTIN  University  GOODMAN  of  British  Columbia,  1970  IN  PARTIAL  FULFILMENT  OF  THE R E Q U I R E M E N T S  FOR THE  DEGREE  THESIS  SUBMITTED  MASTER  OF S C I E N C E  in  the  IN  OF -  NURSING  School  of Nursing  We a c c e p t requi red  THE  this  thesis  as  conforming  to  standard  UNIVERSITY  OF B R I T I S H  Apri I ,  1972  COLUMBIA  the  In presenting  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r  an advanced, degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive f o r s c h o l a r l y purposes may by h i s representatives.  copying of t h i s t h e s i s  be granted by the Head of my Department or I t i s understood that copying or p u b l i c a t i o n  of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission.  Department of The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8, Canada  i i  ABSTRACT This experimental effect of  p l a n n e d t e a c h i n g on t h e  ambulatory  forty of  of  s t u d y was d e s i g n e d t o  cardiac patients.  male and f e m a l e  forty-five  socio-economic  self-medication  status.  lived at  All  They a l l  were t a k i n g  from each g r o u p ,  lived  when t h e y patients factual  visited i n the  patients  in  the  in a  large  a diuretic.  18  They were  clinic.  and  their  experimental  clinic  group  control,  The t w e n t y  g r o u p were g i v e n t h e  during  urban  d i g o x i n and t h i r t y - s i x ,  outpatient  control  low  medical  two g r o u p s , e x p e r i m e n t a l  the  information  who were o v e r t h e age  c l i n i c for  were a l s o t a k i n g  randomly a s s i g n e d to  practices  home and were o f  c e n t r e and a t t e n d e d a n o u t p a t i e n t attention.  the  The s a m p l e was composed o f  cardiac patients  y e a r s , who  evaluate  usual  visit.  received  routine  The t w e n t y  additional  planned t e a c h i n g over a t h i r t y - m i n u t e p e r i o d  by  the  resea r c h e r . The d a t a were g a t h e r e d by means o f a questionnaire  designed to  s e l f - m e d i c a t i o n behavior questionnaire  elicit of  the  was a d m i n i s t e r e d  ten to f o u r t e e n  days f o l l o w i n g  twenty-item  information  regarding  study p o p u l a t i o n . i n t h e homes o f their  visit  to  The  the the  the  patients outpatient  clinic. T h r e e h y p o t h e s e s were t e s t e d of  the  data  in r e l a t i o n  in the  to H y p o t h e s i s I i i i  study.  indicated a  Analysis  i v statistically  significant  self-medication errors a twenty-four-hour  difference  by p a t i e n t s  g r o u p a s compared w i t h the g r o u p made s i g n i f i c a n t l y  types of  errors  to  fewer  i n the  level  of  difference  control  group.  significant  error--that  experimental patients  the  of  in  of  knowledge of  omission.  the  i n the  four there  errors  in  significant  level  the  The t e s t i n g  two g r o u p s o f  g r o u p had a h i g h e r  experimental  There was,  difference  showed a s t a t i s t i c a l l y  The e x p e r i m e n t a l their  The  errors  in  experimental  Although  p e r i o d by p a t i e n t s  however, a s t a t i s t i c a l l y  III  errors.  significant  g r o u p as compared w i t h t h e  Hypothesis  group.  made  d o s a g e and n o n - p r e s c r i b e d m e d i c a t i o n s made  in a twenty-four-hour  of  i n the  of  s t u d i e d with regard to Hypothesis II,  time,  f o u r t h type  control  g r o u p made f e w e r  was n o t a s t a t i s t i c a l l y related  number  i n d i g o x i n and d i u r e t i c s  period  i n the e x p e r i m e n t a l  in the  of  of  difference  patients.  knowledge  of  medications. The s t u d y  implications  for  concludes with consideration n u r s i n g p r a c t i c e and  of  research.  86 pages  ACKNOWLEDGEMENTS My t h a n k s a r e e x p r e s s e d t o B a b c o c k and t h e Hospital  Outpatient  assistance; Columbia f o r statistical Elfert to  staff  and p a t i e n t s  Department f o r  to Dr. F . P . G l i c k of consultative  Dr. of  interviewers,  and t o my p a r e n t s f o r  Vancouver General  the  University  of  British  t i m e on s a m p l e s e l e c t i o n and  and K i r s t e n Weber f o r  M r s . Ruth L a p o i n t e f o r  the  c o o p e r a t i o n and  a n a l y s i s ; t o my c o m m i t t e e ,  the o u t s i d e  D. S . M u n r o e , M r s . D.  s u g g e s t i o n s and Mrs. Winnifred  working their  P r o f e s s o r s Helen  willingly  criticisms; Miller  and  e n c o u r a g e m e n t and  v  and  competently; inspiration.  TABLE  OF  CONTENTS  Pa ge ACKNOWLEDGEMENTS  v  LIST  OF T A B L E S  ix  LIST  OF F I G U R E S  xi  Chapter 1.  INTRODUCTION  1  INTRODUCTION STATEMENT  2.  NEED  1  OF THE PROBLEM  SIGNIFICANCE THE  TO THE PROBLEM  2  OF THE PROBLEM  2  FOR R E S E A R C H  RESUME' OF P R E S E N T INCIDENCE  6  KNOWLEDGE  8  OF S E L F - M E D I C A T I O N  THE  TEACHING  THE  ROLE  FUNCTION  OF THE NURSE  OF A IN  ERRORS NURSE  THE  .  8 12  17  THE D E S I G N OF THE S T U D Y GENERAL AIM  THE  .  14  SUMMARY  SPECIFIC  .  OUTPATIENT  CLINIC  3.  .  19  OF THE STUDY  OBJECTIVES  OF THE STUDY  HYPOTHESES  VARIABLES  INCLUDED  DEFINITION LIMITATIONS  19 19 20  IN  THE STUDY  OF TERMS  20 21  OF THE STUDY  ASSUMPTIONS  23 24  vi  vi i Chapter 4.  Page 25  METHODOLOGY  25  THE  SAMPLE  THE  BIOGRAPHICAL  THE  PLANNED TEACHING  26  THE  QUESTIONNAIRE  27  Purpose  of  the  Construction Pre-test  of  of  5.  .  .  .  27  .  Questionnaire of  the  Validity  28  Questionnaire and  29  . . .  Practicability 30  METHOD OF DATA A N A L Y S I S  33  THE  OF THE  STUDY  SUMMARY  DATA  35  POPULATION  OF THE  35  DATA  37  ANALYSIS  IN  RELATION  TO H Y P O T H E S I S  I  ANALYSIS  IN  RELATION  TO H Y P O T H E S I S  II  . . .  ANALYSIS  IN  RELATION  TO H Y P O T H E S I S  III  .  SUMMARY 6.  Questionnaire  Questionnaire  ANALYSIS  the  the  the  Reliability,  27  Questionnaire  of  Administration  25  DATA  SUMMARY,  OF R E S U L T S OF DATA IMPLICATIONS  AND RECOMMENDATIONS SUMMARY IMPLICATIONS  FOR  RECOMMENDATIONS  FOR  ANALYSIS  NURSING  FOR FURTHER  NURSING  .  .  .  .  .  . .  47 50  .  52  .  53  . . .  55 55  PRACTICE, STUDY  PRACTICE  FOR F U R T H E R  .  STUDY  56 58  BIBLIOGRAPHY  62  APPENDICES  67  A.  Introduction  to  the  Patient  68  vi i i Pa ge B.  Biographical  C.  Semi-Structured Patient  D.  A Teaching  E.  The  F.  List  G.  Statistical  Data  Form  70  Interview  Guide  Followed  in  Teaching Discussion  72 with  a  Patient  75  Questionnaire of  Study  All  80  Medications  Prescribed  Population Treatment  for  the 84  of  the  Data  86  L I S T OF TABLES Table 1.  2.  3.  4.  5.  6.  7.  8.  9.  10.  Page S e x , A g e , L i v i n g A r r a n g e m e n t and T o t a l of M e d i c a t i o n s of P a t i e n t s i n the E x p e r i m e n t a l Group  Number  S e x , A g e , L i v i n g A r r a n g e m e n t and T o t a l of M e d i c a t i o n s of P a t i e n t s i n the C o n t r o l Group  Number  38  39  Number and P e r c e n t a g e o f Types o f S e l f M e d i c a t i o n E r r o r s in M e d i c a t i o n s Other Than D i g o x i n and D i u r e t i c s Made by Both Groups  42  Number o f P a t i e n t s i n B o t h G r o u p s who Made S e l f - M e d i c a t i o n E r r o r s i n the T o t a l M e d i c a t i o n Regimen, w i t h Regard to Age G r o u p , and Mean Number o f E r r o r s p e r P a t i e n t i n E a c h Age Group  44  Number and P e r c e n t a g e o f P a t i e n t s i n B o t h G r o u p s Who Made S e I f - M e d i c a t i o n E r r o r s i n D i g o x i n and D i u r e t i c s a s E v i d e n c e d by t h e Three I n t e r v i e w e r s  48  Number o f S e l f - M e d i c a t i o n E r r o r s and D i u r e t i c s Made P e r P a t i e n t Groups  49  of by  Digoxin Both  Number o f S e l f - M e d i c a t i o n E r r o r s o f T a k i n g N o n - P r e s c r i p t i o n M e d i c a t i o n Made by B o t h Groups  50  Number o f E r r o r s o f O m i s s i o n i n S e l f M e d i c a t i o n o f D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s  51  Number o f E r r o r s o f I m p r o p e r Time i n S e l f M e d i c a t i o n o f D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s  51  Number o f E r r o r s o f I n c o r r e c t Dosage i n S e l f - M e d i c a t i o n o f D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s  52  ix  X  Table 11.  Page Level  of  Digoxin  Knowledge  of  Self-Medication  and D i u r e t i c s  of  Both Groups  of . . . .  53  L I S T OF FIGURES Figure 1.  2.  Page P e r c e n t a g e D i s t r i b u t i o n of S e l f - M e d i c a t i o n E r r o r s i n D i g o x i n and D i u r e t i c s , and O t h e r M e d i c a t i o n s , and A v e r a g e L e v e l o f Knowledge o f D i g o x i n and D i u r e t i c s , and O t h e r M e d i c a t i o n s , o f B o t h E x p e r i m e n t a l and C o n t r o l Groups  41  P e r c e n t a g e D i s t r i b u t i o n of S e l f - M e d i c a t i o n E r r o r s i n t h e T o t a l M e d i c a t i o n Regimen o f B o t h E x p e r i m e n t a l and C o n t r o l G r o u p s w i t h Regard to L i v i n g Arrangements  45  xi  Chapter  1  INTRODUCTION  I.  The the  effect  practices  nursing in The  of  who  experience  literature plays  The forty-five cause  of  were  self-medication was  to  made  the  in  at  the  was  to  evaluate  self-medication  patients  by  this  role  of  and  cardiovascular  on  study  over  home.  the  of  Community  researcher  patients  age  that  living  observation.  The  the  of  treatment  errors  at  home.  medication the  patient.^  numbers  in  this  living  revealed  cardiac  death  population  were  vital  years  of  cardiac  supported a  TO THE PROBLEM  teaching  ambulatory  years,  ambulatory  purpose  planned  self-medication  regimen  is  general of  forty-five  INTRODUCTION  our  over  Canada  population are  of  deemed  to  the  increasing,  individuals  disease.  behavior  in  Therefore  of  this  be  a  segment  timely  and  in a  and  age the  this  study of  group  leading  age of  of  group  the  our  worthwhile  endeavor.  'Amy B . H e c h t , " S e l f - M e d i c a t i o n , What C a n Be D o n e , " N u r s i n g O u t l o o k . V o l . ( A p r i I , 1970), p . 30.  Inaccuracy, and X V I I I , No. 4  p (Ottawa:  Dominion Bureau Queen's Printer  of of  S t a t i s t i c s , Canada C a n a d a , 1970-71),  1  Year  Book  p. 307.  2 II.  STATEMENT OF THE PROBLEM  The s p e c i f i c p u r p o s e o f the  this  s e l f - m e d i c a t i o n p r a c t i c e s of  cardiac living  patients, at  age f o r t y - f i v e  0 . 2 5 mgm. d a i l y ,  All  of  the  patients  and e x c e p t f o r  four  group,  information the  was g i v e n t h e  which p a t i e n t s  outpatient  experimental  group,  usual  clinic.  The c o m p a r i s o n o f  was made i n t e r m s 1. individuals 2. individuals 3. individuals  the  factual  group,  the  planned  researcher.  they  teaching  T h i s g r o u p was researcher  self-medication  practices  of:  number o f  self-medication errors  made by  i n each group type  of  seIf-medication  errors  made by  i n each group level  of  knowledge of m e d i c a t i o n a c t i o n s  of  in each g r o u p . III.  S I G N I F I C A N C E OF THE PROBLEM  The numbers o f forty-five  digoxin  two f r o m e a c h  r e c e i v e when  The o t h e r  for  One g r o u p ,  a l s o encouraged to ask q u e s t i o n s which the answered.  clinic  patients,  was g i v e n a d d i t i o n a l  r e g a r d i n g m e d i c a t i o n s , by the  who were  were t a k i n g  routine  regularly  compare  ambulatory  y e a r s and o v e r ,  t h e y were a l s o t a k i n g a d i u r e t i c .  control  visit  two g r o u p s o f  home and who a t t e n d e d an o u t p a t i e n t  medical a t t e n t i o n .  group,  s t u d y was t o  and o v e r a r e  our p o p u l a t i o n increasing.  i n the In  age g r o u p  1956 t h e  of  population  3 of  Canada i n t h i s  figure  was 5 , 0 9 7 , 4 4 7 ,  In B r i t i s h  The Columbia of  leading  diagnosis  an  cause of death  and d i u r e t i c s .  decreasing."^  ability  determinant patients  despite  Health workers  medications  who make e r r o r s  -"Ibid.,  ten  from t h e i r  p. 2 1 2 .  years.^  British  y e a r s and over  its early  a r e becoming  they  of  is  do s o .  digoxin  origins,  rather  to which p a t i e n t s  i s an  than  increasingly take  their  The  patient's  a t home i s an i m p o r t a n t  of the a t t a i n m e n t  maximum b e n e f i t  in  i n Canada and i n  increasing  and how a c c u r a t e l y  to take  In 1966 t h i s  Many p e r s o n s w i t h a known  is currently  concerned with the extent medications,  individuals  d i s e a s e have p r e s c r i p t i o n s  "Digoxin,  whose v a l u e  130,972  age f o r t y - f i v e  disease.^"  of c a r d i a c  of  in ten years.  i n 1956 o f  was 4 1 1 , 0 9 6 .  increase  individuals  cardiovascular  In 1966 t h i s  an i n c r e a s e of 1 , 0 8 7 , 5 3 3  y e a r s and over  was 5 4 1 , 0 6 8 ,  figure  was 4 , 0 0 9 , 9 1 4 .  Columbia the p o p u l a t i o n  aged f o r t y - f i v e  agent  age g r o u p  of treatment g o a l s . ^  in self-medication  will  not  prescribed medications,  ^Ibid.,  Those receive  or w o r s e ,  p. 3 0 7 .  5 R o b e r t P . W a l t o n and P e t e r C . G a z e s , " C a r d i a c G l y c o s i d e s I I : P h a r m a c o l o g y and C l i n i c a l U s e , " D r i I I ' s P h a r m a c o I o q y i n Med i c i n e . e d . J o s e p h R. D i p a l m a (New Y o r k : M c G r a w - H i l l Book Company, 1 9 7 1 ) , p . 7 8 0 . Mary V . M a r s t o n , " C o m p l i a n c e w i t h M e d i c a l R e g i m e n s : A Review of the L i t e r a t u r e , " Nursing R e s e a r c h , V o l . X I X , No. 4 ( J u l y - A u g u s t , 1 9 7 0 ) , p . 3 1 2 . ^Norman H . B e r k o w i t z e t a I., " P a t i e n t F o l l o w - T h r o u g h i n the O u t p a t i e n t Department," Nursing R e s e a r c h , V o l . X I I , No. 1 ( W i n t e r , 1 9 6 3 ) , p . 1 6 .  suffer  irreparable  harm.  0  P r a c t i c a l e x p e r i e n c e has d e m o n s t r a t e d t h a t . . . a l e r t and i n f o r m e d c l i n i c a l a t t e n t i o n i s needed a t a l l t i m e s i n the a d m i n i s t r a t i o n of the s i n g u l a r l y p o t e n t d r u g , d i g o x i n.9 Encouraging patients o r d e r s and r e c o m m e n d a t i o n s Nursing for,  i s one d i s c i p l i n e  and i m p l e m e n t i n g  community. need.  i s of  s t u d i e s which w i l l  their  concern to  physician's nursing.  considered essential  care f o r  Before planning  Schwartz says,  to f o l l o w  individual  c a r e , the  "There  provide  the  ambulatory asked, "It  patients  "What a b o u t  i s a mistake  to  i s a r e c o g n i z e d need about  medications correct Iy. Cap Ian e t variables for  patients  1 , 1  for  patients."  i n a study of  everywhere e l s e ? "  that patients  at  1 1  1 0  elderly  She t h e n Hecht says  home t a k e  their  2  a l . studied  patient  °Hecht,  of  the  problems  made s e l f - m e d i c a t i o n e r r o r s .  think  the  n u r s e must know  information  patients  planning  in  a s s o c i a t e d w i t h s e l f - m e d i c a t i o n of a m b u l a t o r y She f o u n d t h a t 59 p e r c e n t  to  the  satisfaction  op. c i t . ,  ^ W a l t o n and G a z e s ,  p.  rank  order  of  in outpatient  important clinic  31.  op. c i t . ,  p.  781.  ° D o r i s S c h w a r t z , B a r b a r a H e n l e y , and L e o n a r d Z e i t z The E l d e r l y A m b u I a t o r y P a t i e n t : Nurs i ng and P s y c h o I o q i caI Needs (New Y o r k ; The Macmi I Ian Company, 1964), p . 109. 1  D o r i s S c h w a r t z , " M e d i c a t i o n E r r o r s Made by Aged P a t i e n t s , " Ameri c a n J o u r n a I o f N u r s i n g . V o l . L X I I , N o . 8 ( A u g u s t , 1962), p . 51. 1 1  l 2  Hecht,  op. c i t . ,  p.  30.  5  services.  She f o u n d  following  instructions  among t h e  twenty-two  Self-medication ambulatory This  the  for  variables  cardiac patients  indicates  compliant  a need f o r  if  with a they  considered  treatment  of  patients  the  the  only  by  perform  long-term  illness  careful  report  to  be e s s e n t i a l  ambulatory  patients." ^ 1  to  1  medications  Methods of must  be  teaching  reportedly  "teaching  1 2 1  "  is  successful  "The t e a c h i n g  patients  which  themselves.  are  the  h a s been a c c e p t e d as an i n t e g r a l  function." ^  second  instruction,"  that  in  patients.  for  teaching.  given  has  home t r e a t m e n t  patient  are  patient  ranked  identified  must  s a y s D a v i s , and M a l o n e e t a I. generally  difficulty  home t r e a t m e n t  is frequently  "Patients more  that  p a r t of about  a  of nurse's  their  explored.17  l e a n o r Cap Ian and M a r v i n B. S u s s m a n , " R a n k O r d e r o f I m p o r t a n t V a r i a b l e s f o r P a t i e n t and S t a f f S a t i s f a c t i o n w i t h O u t p a t i e n t S e r v i c e , " J o u r n a l o f H e a l t h and Human B e h a v i o r . V o l . V I I , N o . 2 (Summer, 1 9 6 6 ) , p . 1 3 5 . ^ M i l t o n S. Davis, " V a r i a t i o n s in P a t i e n t s ' C o m p l i a n c e w i t h D o c t o r s ' A d v i c e : An E m p i r i c a l A n a l y s i s P a t t e r n s o f C o m m u n i c a t i o n , " Amer i c a n J o u r n a I o f Pub Ii c H e a I t h . V o l . L V I 1 1 , No. 2 ( F e b r u a r y , 1 9 6 8 ) , p. 2 7 5 .  of  ^ M a r y M a l o n e , Norman H . B e r k o w i t z , and M a l c o l m W. K l e i n , "The Paradox i n N u r s i n g , " A m e r i c a n JournaI of N u r s i n g . V o l . L X I , No. 9 (September, 1961), p. 5 3 . 1  A  p.  I ^ L o i s A . M o n t e i r o , " N o t e s on P a t i e n t T e a c h i n g — N e g l e c t e d A r e a , " N u r s i n g F o r u m . V o l . I l l , No. 1 ( 1 9 6 4 )  ,  2 6 .  'Hecht, Be D o n e , " p . 3 1 . 1  "Self-Medication,  Inaccuracy,  and What Can  6 IV. Fox,  "A P r o p o s e d Model  for  I d e n t i f y i n g Research Areas in N u r s i n g , " c i t e s  the  for  studies  in his  THE NEED FOR RESEARCH  i n the  article  area of  nurse-patient  need  teaching.  He  states: I n v e s t i g a t i o n s a r e needed t o i d e n t i f y t h e need f o r t e a c h i n g , . . . t h e methods o f t e a c h i n g , t h e e f f e c t i v e n e s s w i t h w h i c h i t i s l e a r n e d , and t h e e x t e n t to which i t i s a c t e d upon.18 The need f o r g r o u p who a r e says the  chronically research. special  chronically  number o f  increasing.  However, ill This  indicated  i n the  the  has been  ill  ill  from the  patients  studies of  largely  a study  in the  older  age  i s e x p r e s s e d by M a c k .  group  chronically  consideration  time of  patients  sociological  The need f o r waiting  studying  of  of  older  ignored  older  She  people  p e o p l e who a r e in the  existing  o l d e r age g r o u p m e r i t s research  some  student. ^ 1  more e f f e c t i v e  i n an o u t p a t i e n t  are  use  clinic  of  is  statement:  S y s t e m a t i c o b s e r v a t i o n of t h i r t y - o n e p a t i e n t s a t t e n d i n g a c l i n i c r e v e a l e d t h a t most o f t h e p a t i e n t s s p e n t f o r t y - f i v e m i n u t e s t o one h o u r i n t h e w a i t i n g r o o m , and most s p e n t t h i s w a i t i n g t i m e d o i n g n o t h i n g . ^  1  Pi  ' D a v i d J . F o x , " A P r o p o s e d Model f o r Research Areas in N u r s i n g , " Nursing Research, No. 1 ( W i n t e r , 1 9 6 4 ) , p. 3 4 .  Identifying Vol. XIII,  ^ M a r j o r i e J . M a c k , "The P e r s o n a l A d j u s t m e n t C h r o n i c a l l y I I I O l d P e o p l e Under Home C a r e , " N u r s i n g R e s e a r c h . V o l . I, N o . 1 ( J u n e , 1 9 5 2 ) , p . 9 . 1  20  of  E v e l y n R. H a y e s , " C l i n i c W a i t i n g Room E x p e r i e n c e : An E x p l o r a t o r y S t u d y , " N u r s i ng R e s e a r c h . V o l . X V I I , N o . 4 ( J u l y - A u g u s t , 1 9 6 8 ) , p. 364.  7  It  is  suggested  provided  which There  that might  is  self-medication homes.  One  reveals  a  "I  of  forget."  states made  the  by  of  the  which of  six  of  a  weeks.  treatment,  yet  latent  omission  cardiac  interference study  about were  in  their eleven  teaching  over was  for  a  period  noted.  therapeutic  passive  out  self-medication  treatment,  the  desire  with  was,  patients  for  indicated  errors  health  a  by  the  of  had  of  given  gave  made  They  reason  therapy  they  An a b s e n c e  medications.  their  reasons  their  of  in  of  error  this  information  follow-up  frequent  in  lacked  care.  most  part  Patients  patient  digoxin  errors  thirteen  be  the  and  of  on  The  made  of  the  patients  patients  who  The  studied  vital  on  knowledge.  forgetting  1 3 patients  their  forty  could  improving  cardiac  study  patients.  in  studies  o m i s s i o n was  A summary  played  of  2 6 patients  error  were  of of  patient  Another  experiences  effective  paucity  study  of  2 1  activities.  be  practices  the  these  omissions  a  such  lack  fourteen  educational  effects  regarding  their  self-sufficiency  pp and  increased A  teaching  need a  knowledge. for  cardiac  c  -  research patient  into about  the  effectiveness  medications  is  of  indicated.  Pi R i t a M. B r k i c h , " A S t u d y t o D e t e r m i n e how View T h e i r D i g o x i n T h e r a p y " ( u n p u b l i s h e d Master's dissertation, McGill University, 1 9 6 9 ) , p. 2 8 .  Patients  I r e n e E . Nordwich, "Concerns of C a r d i a c P a t i e n t s R e g a r d i n g T h e i r A b i l i t y to Implement the P r e s c r i b e d Drug Therapy" (unpublished M a s t e r ' s d i s s e r t a t i o n , U n i v e r s i t y of Western O n t a r i o , 1 9 7 0 ) , p. 1 2 1 . 2 2  Chapter  2  RESUME OF PRESENT KNOWLEDGE I.  INCIDENCE OF SELF-MEDICATION ERRORS  The  literature  r e v e a l s numerous s t u d i e s  self-medication  behavior  lived at  Few o f  the  home.  self-medication  patients.  a range  of  studies  cardiac  "A r e v i e w of  the  non-compliant  says there  are  collecting  methods,  when t h e s e  s t u d i e s are examined as a w h o l e .  of  differences,  studies to  failed  at to  but  of  patients  r e g i m e n s . H e  and a v a r i e t y  comply w i t h d o c t o r ' s  the  of  emerges  Regardless  patients  orders.  t r e a t m e n t o r d e r s as w e l l  data  as  in  He  most  refers  to  orders.  In a s t u d y no v a r i a t i o n  done by D a v i s h i m s e l f ,  in p a t i e n t  can be a t t r i b u t e d  2  of  nevertheless a pattern  l e a s t one t h i r d  both p h y s i c i a n ' s  medication  populations  investigated  literature  reportedly  various  studied  patients.  o f f r o m 15 t o 93 p e r c e n t with medical  the  Most p a t i e n t s  these p u b l i s h e d  behavior  Davis w r i t e s , demonstrates  of  of  3Qavis,  to  op.  he r e p o r t s  compliance with medical  demographic c h a r a c t e r i s t i c s  cit.,  p.  274.  8  that  regimens peculiar  to  the  patient  educati o n .  such as a g e , s e x , m a r i t a l  status  and  2 4  Marston w r i t e s revealed  little  or  behavior  with regard  that a review  to medical  Male p a t i e n t s  study  group  their  medical  the  no a s s o c i a t i o n e x i s t e d  and s o c i o - e c o n o m i c s t a t u s .  cardiovascular  of  regimen.  compliance  r e g i m e n s and s e x ,  sixty-five  to  between  education  ^  d i s e a s e were  admitted  literature  y e a r s and u n d e r  studied,  and 30 p e r c e n t  some d i s c r e p a n c y "A p a t i e n t  with  in  of  the  compliance  with  does not  accept  generally 26  everything  his  doctor  patient  not  completed  is  A study program follow  Evidence clinic  2  P.  312.  patients  of  medication  regimen  prescribed  regimens  Ibid.,  p.  5(v!arston,  p^r  twenty-six  from these  these  patients  importance to a l l  to  the  prescription.  sixteen  s u g g e s t e d the  2 4  Responsibility  that  obtained  medication  with  involving  revealed the  recommends."  of  on a home  patients  by t h e i r  while  clearly  outpatients.  failed  care to  physicians,  attending  a  explaining  27  278. "Compliance with Medical  Regimens,"  M i l t o n S . D a v i s and R o b e r t L . E i c h h o r n , "Compliance With Medical Regimens: A Panel S t u d y , " Journal o f H e a l t h and Human B e h a v i o r . V o l . I V , N o . 4 ( W i n t e r , 1 9 6 3 ) , p. 2 4 9 . 27 E l i z a b e t h B . C u r t i s , " M e d i c a t i o n E r r o r s Made by P a t i e n t s , " N u r s i n g O u t l o o k . V o l . I X , N o . 5 ( M a y , 1961), p . 290.  1 0  Two s t u d i e s , of  pregnant  medication  one o f  women t a k i n g  Both r e s e a r c h e r s the  "what" In  iron  noncompliance  b e t w e e n age and s o c i a l  a sample o f  pi I I s , ^  rates.  of  western  and o v e r .  It  medication  errors.  the  No c o r r e l a t i o n  medication  patients  was f o u n d  that 5 9  percent  depend upon t h e  patient  take  this  continue  irregularity  made.  teaching  as  to  sixty of  the  to  and the  years of  age  patients  made  increasing  medications  concentrate  at  the need  to  home, make  it  on ways o f  in order  using  identifying  to attempt  to  percentage . 3 0 "  tuberculosis, taking  to  who make e r r o r s ,  A study  were  errors  found  The r e s e a r c h e r s e m p h a s i z e d t h a t errors  reduce  was  self-  prescribed.  who were  medication  patients  another  U n i t e d S t a t e s a s t u d y was done  consequences of  those  and  0  revealed high  c l a s s and number o f  fifty-nine  necessary to  patients^  recommended more p a t i e n t  and "why" the  diabetic  of  one h u n d r e d  showed t h a t  their  drugs  may n o t  patients  twenty-four  of  i n an i r r e g u l a r  allow  the  patient  with  pulmonary  these fashion.  to  patients "This  respond to  the  ^ J u l i a W a t k i n s , "A Study of D i a b e t i c P a t i e n t s a t H o m e , " Ameri c a n J o u r n a I o f Pub Ii c H e a I t h . V o l . L V I I , N o . 3 ( M a r c h , 1 9 6 7 ) , p. 4 5 7 . po ^ J o h n B o n n a r , A . G o l d b e r g , and J . S m i t h , "Do P r e g n a n t Women Take T h e i r I r o n ? " The L a n c e t ( M a r c h , 1 9 6 9 ) , P. 4 5 7 . 2  - ^ E l i z a b e t h N e e l y and M a x i n e P a t r i c k , " P r o b l e m s o f Aged P e r s o n s T a k i n g M e d i c a t i o n s a t H o m e , " N u r s i n g R e s e a r c h , V o l . X V I I , No. 1 ( J a n u a r y - F e b r u a r y , 1 9 6 8 ) , p. 5 5 .  11 medication  therapeutically,"  feels  the  that  the  researcher.^  of  the  patient  may be i m p r o v e d by e x p l a i n i n g  the  course of  chemotherapy  cooperation  states  to  the  Two d o c t o r s pediatric  clinic  interviewing of  the  the p a t i e n t ' s  half  the  taking  the  studied f i f t y - n i n e  parents  therapy  They f e l t  patients* factor  the  in determining  to  parents.  first  had a r e l a t i v e l y  who were  time while high  give  for  Secondly,  i n San F r a n c i s c o ,  the  stopped  directions  i n the m e d i c a t i o n  patients  that  medication  p h y s i c i a n c o u l d be a  103  residing  prescribed medication  was f o u n d  These r e s e a r c h e r s  by t h e  the  inspection  penicillin  t r e a t m e n t or  cooperation  prescribed for clinic,  It  noncompliance w i t h the  H a l l b u r g found t h a t  outpatient  course of  perhaps the  relationship  medications  intended  The s t u d y was done by  c h i l d r e n a n d by  t h i r d day.  understood  y e a r s o l d and o v e r ,  the  children at a  containers.  on a t e n - d a y  d r u g by t h e  were n o t  of  medication  two p o s s i b l e r e a s o n s f o r regime.  self-medication  patient.  i n New Y o r k s t a t e .  children  in  He  1  large regime.^ sixty  and who had visiting  noncompliance  an with  regimens.  - ^ W a l l a c e F o x , "The P r o b l e m o f S e l f - A d m i n i s t r a t i o n of Drugs; w i t h P a r t i c u l a r Reference to Pulmonary T u b e r c u l o s i s , " T u b e r c I e . V o l . XXXIX ( O c t o b e r , 1958), p . 271. 3 A b r a h a m B. Bergman and R i c h a r d J . W e r n e r , " F a i l u r e o f C h i l d r e n t o R e c e i v e P e n i c i l l i n by M o u t h , " New Enq I and J o u r n a I o f Medi c i n e . V o l . C C L X V I I I , N o . 25 ( J u n e 13, 1963), P . 1337. 2  - ^ J e a n n e C. H a l l b u r g , "A D e c i s i o n Making Approach as a Teaching-Learning Strategy for Preparing Patients for Self C a r e " (unpublished D o c t o r ' s d i s s e r t a t i o n , U n i v e r s i t y of C a l i f o r n i a , 1969), p . 53.  II. It  THE TEACHING FUNCTION OF A NURSE  no  therapeutic  longer  drug  if  suffices the  patient  m e d i c a t i o n s as d i r e c t e d . patients  involving  certainly  r e f u s e s to  take  his  programs  for  techniques  are  Experimental  teaching as a part  team.  In  more r e s p o n s i b i l i t y  for  shifted  from d o c t o r ,  be t h a t  the  nursing  than  to  s c i e n c e of the  our  nurse,  with pacemakers. and d i u r e t i c s  Both t h e i r  knowledge  with teaching. involvement  to  disease is  to  of  in teaching  points  out  may  self-care  improve  the  to  commonly  and m e d i c a t i o n - t a k i n g  The s t u d y  "It  being well to  pathology."-^  These p a t i e n t s  prescribed  function  i s more p e r t i n e n t  d i s e a s e or teaching  their  s o c i e t y more and  patient.  communication  on t h e  of  contemporary  t r e a t m e n t of  s c i e n c e of  Kos r e p o r t s  digoxin  effective  warranted.  health  patients  have an  special education  Nurses accept on t h e  to  heart  have action.  behavior  need f o r  elderly  improved  nurses*  patients.^6  14  D a v i d B e r r y , A l a n R o s s , and K u r t D e u s c h l e , " T u b e r c u l o u s P a t i e n t s T r e a t e d a t Home. C o m p a r i s o n o f R e g u l a r and I r r e g u l a r S e I f - M e d i c a t i o n G r o u p s , " R e v i e w o f R e s p i r a t o r y D i s e a s e s . V o l . L X X X V I I I , No. 6 (December, 1 9 6 3 ) , p. 7 7 1 . • ^ D o r o t h y M. S m i t h , " M y t h and Method i n N u r s i n g P r a c t i c e , " Ameri can J o u r n a I o f N u r s i n g . Vo I . L X V I , N o . I ( F e b r u a r y , 1 9 6 4 ) , p. 7 0 . J  36  B a r b a r a Kos and P a m e l a C u l b e r t , " T e a c h i n g P a t i e n t s a b o u t P a c e m a k e r s , " Amer i can J o u r n a I o f N u r s i n g . V o l . L X X I , No. 3 ( M a r c h , 1 9 7 1 ) , p. 5 2 6 .  13 Studies outpatient the  clinics  nurses'  Health  of  role  teaching  patient  to  planned  suggest that  is is  one e f f e c t i v e  cope w i t h p r e s e n t  evidence e x i s t s  has o n l y  had s p o r a d i c Patients  knowledge  opinions  that  ago a s 1 9 5 3 , S t r e e t e r departments  of  in  aspect  it  is  method  of  assisting  health  approach  of  realized.-^ the  problems.  to h e a l t h  care  and e m p h a s i s . ^ 8 to  and more  wrote,  nursing  particular  help  treatment.  more f r e q u e n t l y  patients  than  this  nurses  their  to  and f u t u r e  support  expect  about  this  i d e a l i z e d more  However,  for  instruction  They a r e  it  As  is essential  conduct  active  need  voicing  vehement I y . ^  "Today  service  them meet t h e  their  long that  teaching  40 programs her to  for  patients  .  teaching  function  will  cope w i t h  their  .  health  .  ." assist  problems  "The n u r s e who the  patient  more  increases  and h i s  family  effectiveIy.  37jeanne C. H a l l b u r g , "Teaching P a t i e n t s S e l f - C a r e , " Nurs i ng C I i n i cs o f N o r t h A m e r i c a . V o l . V , No. 2 ( J u n e , 1 9 7 0 ) , p. 2 2 3 . -z o  A r l e n e M. P u t t , "One E x p e r i m e n t i n N u r s i n g A d u l t s w i t h P e p t i c U l c e r s , " N u r s i n g R e s e a r c h , V o l . X I X , No. 6 (November-December, 1 9 7 0 ) , p. 4 9 2 . - ^ S t e l l a Hay and H e l e n A n d e r s o n , " A r e N u r s e s M e e t i n g t h e P a t i e n t s ' N e e d s ? " Ameri c a n J o u r n a I o f Nurs i n g , V o l . L X I I I , N o . 12 ( D e c e m b e r , 1 9 6 3 ) , p . 9 7 .  40 V i r g i n i a S t r e e t e r , "The N u r s e ' s R e s p o n s i b i l i t y f o r T e a c h i ng P a t i e n t s , " Amer i can J o u r n a I o f N u r s i n g , V o I . LI 1 1 , No. 7 ( J u l y , 1 9 5 3 ) , p. 8 1 8 . 41 Margaret L. P o h I , " T e a c h i n g A c t i v i t i e s of the N u r s i n g P r a c t i t i o n e r , " N u r s i n g R e s e a r c h . V o l . XVI ( W i n t e r , 1965), P. 5 .  14 Attitudes be  influenced.  lifetime  of  Instruction  attitudes,  method w h i c h  is  administration  patients  but  toward  several  being t r i e d  program w i l l for  their  i n some h o s p i t a l s  is  self-  Such a p r o g r a m i s  being  give patients  d i s c h a r g e to  2  hospital  coast.  It  in a  large  i s hoped t h a t  i n d e p e n d e n c e , and a  their  alter "A  out 2 1  can  s t e p s c a n be t a k e n .  of m e d i c a t i o n s . " '  on C a n a d a ' s w e s t  medications  by n u r s e s c a n n o t a l w a y s  conducted in a r e h a b i l i t a t i o n centre  their  homes and t h e  task  urban this  preparation of  self-  medi c a t i o n . I t has b r o u g h t t o t h e a t t e n t i o n o f t h e h o s p i t a l s t a f f , t h e g r e a t h a z a r d s i n v o l v e d t o p a t i e n t s who a r e d i s c h a r g e d t o t h e home e n v i r o n m e n t w i t h o u t t h e n e c e s s a r y t r a i n i n g and i n s t r u c t i o n on t h e p r o p e r usage o f d r u g s . ^ 3 Follow-up have n o t  s t u d i e s on t h e s e p a t i e n t s  d i s c h a r g e home  been d o n e . III.  THE ROLE OF THE NURSE IN THE OUTPATIENT C L I N I C  Health s e r v i c e s are P r e v e n t i o n of clinics  after  undergoing  rapid  i l l n e s s and h e a l t h m a i n t e n a n c e  and i n t h e  patients'  homes a r e  transformation. in  ambulatory  being s t r e s s e d .  ^ H e c h t , " S e l f - M e d i c a t i o n , Inaccuracy, Be D o n e , " p . 3 1 .  and What Can  ^ M a r y F a l c o n e r , "An E x p e r i m e n t a l Program in S e l f M e d i c a t i o n , " C a n a d i an P h a r m a c e u t i ca I J o u r n a I . ( M a y , 1 971 ) , p. 2 3 .  15 More o u t p a t i e n t  care  i s being  on t h e p r a c t i c e  of preventive  consideredThe  emphasis  is  medicine.^  B e n n i s e t a l . recommend  that  n u r s e s be a s s i g n e d  to  46 the  outpatient  nursing  clinic  profession  primarily  recognizes  to teach p a t i e n t s . patient  i m p o r t a n t f u n c t i o n o f the n u r s e , researchers fact  has n o t e d ,  that pivotal  a neglected  area  Fischer outpatient  units  must a c t b e f o r e  y e t , as t h i s  "Much o f o u r d a t a  as t e a c h i n g in  writes more  that  social  has b o r n e  of out the  is  often  changes a r e making  important than ever  the f u l l  potential  each of which  implies  clinics  a definite  These a r e :  teaching  before  of these  functions,  health  group  practice."^  She a d d s t h a t o u t p a t i e n t  sick,  a s an  i s said to be, i t  realized.  responsibility.  teaching  The  t r e a t i n g the 48 and r e s e a r c h .  units have  and n u r s e s c a n be three  nursing ambulatory  u  ^"Esther L u c i l e Brown, N u r s i n g R e c o n s i d e r e d . A S t u d y o f Change ( T o r o n t o : J . B . L i p p i n c o t t Company, 1970), p . 118. Ac  -^Based on a l e c t u r e by D r . S t a n l e y B l o c k , I l l i n o i s I n s t i t u t e of Technology i n C h i c a g o , a t the U n i v e r s i t y of B r i t i s h C o l u m b i a , M a r c h 9, 1 9 7 1 . 46 W a r r e n G . B e n n i s e t a I., The RoIe o f t h e Nurse i n t h e O u t p a t i e n t D e p a r t m e n t (New Y o r k : A m e r i c a n N u r s e s ' F o u n d a t i o n , I n c . , 1961), p . 65. 4 7  Ibid.,  48  p.  58.  M e r c e d e s M. F i s c h e r , " O u t p a t i e n t D e p a r t m e n t s Have a Long Way To G o , " A m e r i c a n J o u r n a I o f N u r s i n g . V o l . L X I , No. 8 ( A u g u s t , 1961), p . 56.  16  "Time  is  currently  commodities."^ Yet time  spent  follows  by p a t i e n t s being  that  is  patient  t e a c h i n g w o u l d meet t h e  medical  doctor  outpatient  these p a t i e n t s  time  use o f  clinic  writes  were s a t i s f i e d  He a d d s t h a t 6 0 p e r c e n t or  the  or  criticism.^  Sussman e t a I. income p a t i e n t s outpatient indicate  tend  clinic.-*  2  ^Hayes,  j  n  e  patient  and  at  a of  and  physician regarding of  these  patients  people  care they  often  receive  their had an tend  without  1  state  to  the  l e s s - e d u c a t e d and  be most s a t i s f i e d  Patient  a communication  relationship.^  the  information  l e s s and t h e s e  be p a s s i v e and t o a c c e p t t h e  question  Hayes s u g g e s t s  t h a t 8 5 to 9 5 percent  condition.  grade e d u c a t i o n  wisely.  outpatient  150 patients  w i t h th e  r e c e i v e d from  valued  time.^  who s t u d i e d  they  to  rooms o f  needs o f  explanation  eighth  s h o u l d be u s e d  used e f f e c t i v e l y .  a more p r o d u c t i v e  A student  o u r s o c i e t y ' s most  in waiting  clinics  implement  not  It  one o f  with  comments d o ,  barrier  outpatient  i n the  low-  the  however,  doctor-patient  department  staff  " C l i n i c W a i t i n g Room E x p e r i e n c e , " p .  361 .  5°lbid. ^ A n d r e w W. F i s h e r , " P a t i e n t s ' E v a l u a t i o n o f O u t p a t i e n t M e d i c a l C a r e , " J o u r n a I o f Medi caI E d u c a t i o n . V o l . X L V I , No. 3 ( M a r c h , 1 9 7 1 ) , p. 2 4 2 . 1  5 M a r v i n B . Sussman e t a I., The W a l k i n g P a t i e n t : A S t u d y i n O u t p a t i e n t C a r e ( C l e v e l a n d : The P r e s s o f W e s t e r n R e s e r v e U n i v e r s i t y , 1 9 6 7 ) , p. 7 6 . 2  5 3  Ibid.,  p.  69.  17 underestimate  the  These f i n d i n g s for of  teaching the  patients*  by Sussman e t a l .  by t h e  patient  unique p o s i t i o n  i n the  health-education this  is  patient  that  the  t h a t the  patient  indicates  not  o u t p a t i e n t department  program."55  unique p o s i t i o n is  of  in a state  has made t h e  IV. A r e v i e w of  of  effort  the  nurse.  The  readiness. to  come t o  i s the  first  The the  fact clinic,  have  presence of  patient health  is  the  most  problem.  l e a r n r e m a r k a b l y we I I . " 5 6 SUMMARY  literature  indicates that  homes i s r e l a t i v e l y  The numerous s t u d i e s  i n c l u d e a wide range of  numbers and t y p e s o f  the  medication  in t h e i r  p.  in a  two  noncompliance with p r e s c r i b e d  lbid.,  is  Windemuth a s s e r t s  r e g i m e n s by p a t i e n t s  5 4  receptiveness  the  c l i n i c a t a t i m e when the  And Windemuth a d d s , " A d u l t s  of  need  to  in doing something about h i s  f r e q u e n c y of  the  contribution  the  The s e c o n d r e a s o n g i v e n  i n the  a variety  only  t h a t he has a need w h i c h he w i s h e s t o  satisfied.  interested  2  n u r s e , but a l s o the  t o make a s i g n i f i c a n t  reasons f o r  nurse  clinic  indicate  information.^ ''  to such t e a c h i n g .  "The nurse  total  eagerness for  high.  settings,  m e d i c a t i o n s per  and  patient.  130.  5 5 A u d r e y W i n d e m u t h , The N u r s e i n t h e O u t p a t i e n t D e p a r t m e n t (New Y o r k : The Macmi I Ian Company, 1 9 5 7 ) , p . 1 0 5 . 5 6  Ibid.,  p. 1 0 7 .  18 Demographic race,  characteristics  marital  medical  status,  one by N o r d w i c  digoxin  of  is  by t h e  generally  the  It  i n the  standing, practice  but  nurse.  the  most o f  of  opportunity self-care  the  the  of  the  nurse  with time to  57f\jordwich,  of  of  i n the  i n most patient is  be  over-  literature the  reviewed.  nurse  is  long-  studies  of  its  i n the  literature.  outpatient  clinic  e m p h a s i s on p r e v e n t i v e teaching  spare.  function  This affords  patients  of  their  " C o n c e r n s of C a r d i a c to  Berkowitz,  medicine  the  nurse.  patient her  contribution in  of  successful  receives a receptive  5 8 e r k i c h , "A S t u d y Digoxin Therapy."  59Malone, N u r s i n g , " p. 5 3 .  cannot  number o f  t o make a s i g n i f i c a n t of ambulatory  the  are a v a i l a b l e  nurse  a contemporary  clinic  J U  and a s p e c t s  "teaching  to  the  function  a limited  importance  audience,  Their  patients"-^  teaching  The r o l e  In  Brkich,  need f o r  that  be e s s e n t i a l  and e f f e c t i v e n e s s  reiterates  by  and  these  importance  the  The n o t i o n  permeates  only  paramount  e x p r e s s i o n of  treatment of ambulatory  Interest  other  cardiac patients  of  considered to  emphasized.  education  sex,  therapy.  studies  teaching  s u c h as a g e ,  O n l y two o f  and t h e  A consideration  and t h e  patient  socio-economic status,  described populations  these  the  d i a g n o s i s are a l s o v a r i e d .  studies,  their  of  the to  the  homes.  Patients."  Determine  how P a t i e n t s  View  and K l e i n ,  "The P a r a d o x  in  Chapter  3  THE DESIGN OF THE STUDY I. The  general  GENERAL AIM OF THE STUDY aim of  the  s e l f - m e d i c a t i o n p r a c t i c e s of cardiac and  living  at  group, type  two g r o u p s o f  who were o v e r f o r t y - f i v e  home.  mgm. d a i l y ,  0.25  of  patients  s t u d y was t o  All  of  the  and e x c e p t f o r  t h e y were a l s o  patients four  as w e l l  the  ambulatory y e a r s of  age,  were t a k i n g  patients,  taking a d i u r e t i c .  of m e d i c a t i o n e r r o r s  compare  digoxin  two f r o m e a c h  The number  as the  and  individual's  level  k n o w l e d g e a b o u t h i s m e d i c a t i o n s were c o m p a r e d . One  routine  group,  factual  when t h e y  visit  experimental regarding  II. 1.  control  information the  group,  their  the  clinic.  m e d i c a t i o n s , by t h e  regularly  usual receive  The o t h e r  group,  planned  teaching  was g i v e n a d d i t i o n a l  the  researcher.  S P E C I F I C OBJECTIVES OF THE STUDY the  number o f  d i g o x i n and d i u r e t i c s  g r o u p a s compared w i t h t h e hour  which p a t i e n t s  outpatient  To d e t e r m i n e  m e d i c a t i o n of  g r o u p , was g i v e n t h e  control  errors  in  made by t h e group,  in a  selfexperimental  twenty-four-  period. 2.  To d e t e r m i n e  m e d i c a t i o n of  the  type  of  d i g o x i n and d i u r e t i c s 19  errors  in  made by t h e  selfexperimental  20  g r o u p a s compared w i t h t h e hour  To d e t e r m i n e  medication of  the  III. Hypothesi s H  0  There  by members o f members o f  the  Hypothes i s  II.  0  the  Hypothesis H  Q  twenty-four-  the  the  knowledge of  of  the  self-  experimental  THE HYPOTHESES  errors  is  i n the  made i n a t w e n t y - f o u r - h o u r  number period  g r o u p a s compared w i t h  group.  no s i g n i f i c a n t  errors  difference  in the  made i n a t w e n t y - f o u r - h o u r  experimental  control  difference  type period  g r o u p a s compared w i t h  group.  III. There  o f members o f  i s no s i g n i f i c a n t  s e l f - m e d i c a t i o n of  the e x p e r i m e n t a l  control IV. The  of  group.  no s i g n i f i c a n t  control  knowledge of  the  control  experimental  seIf-medication  members o f  of  is  There  by members o f  of  in a  I.  seIf-medication  H  level  d i g o x i n and d i u r e t i c s  g r o u p a s compared w i t h t h e  of  group,  period. 3.  of  control  difference d i g o x i n and  in the  level  diuretics,  g r o u p as compared w i t h members  group. VARIABLES INCLUDED  independent  p l a n n e d t e a c h i n g by t h e  variable  IN THE STUDY  i n the  researcher.  It  s t u d y was was t h i s  the variable  2 1  which purposely a l t e r e d application  to  the  conditions  experimental  i n the  s t u d y by  group.  The d e p e n d e n t v a r i a b l e was p a t i e n t behavior.  This c r i t e r i o n  teaching.  T h i s measured e f f e c t  w i t h the their item  entire  visit  the  self-medication  measured the e f f e c t  clinic,  of  patient  was o b t a i n e d f r o m  study population  to  its  ten to f o u r t e e n  by a d m i n i s t r a t i o n  of  interviews days  the  twenty-  questionnaire. V.  D E F I N I T I O N OF TERMS  Self-medication without patient  error:  administers  medication:  (a)  o r d e r e d by h i s  physician  (b)  at  the  correct  time  (c)  i n the  correct  dosage.  Self-medication  error:  m e d i c a t i o n which  is:  (a)  patient  t a k e n by the  and n o t  p r e s c r i b e d by  his  p h y s i c i an (b)  o r d e r e d by t h e  p h y s i c i a n but  not  patient (c)  taken at  (d)  taken  Type o f the  the  incorrect  i n an i n c o r r e c t  medication different  time dosage.  error: types of  errors  are:  t a k e n by  after  the  22  (a)  error the  of  taking  patient's  a medication  not  by  physician  (b)  error  of  omission  (c)  error  of  taking  a medication at  (d)  error  of  taking  a medication  Incorrect  prescribed  the  incorrect  time  i n an i n c o r r e c t  dosage.  time:  medication T.I.D., Incorrect  is  not  or Q . I . D .  t a k e n by t h e  patient  O.D.,  B.I.D.,  as p r e s c r i b e d by h i s  physician.  t a k e n by t h e  i n numbers  dosage:  medication tablets,  i s not  patient  c a p s u l e s o r s p o o n f u l s a s p r e s c r i b e d by  of  his  phys i c i a n . Level  of  knowledge:  in t h i s low,  study  moderate  knowledge (a)  three  l e v e l s of  and h i g h .  of answers to  patient  knows t h e  These the  trade  knowledge are  considered:  levels pertain  following names o f  to  questions: the  medications  take n (b)  patient be  knows a t  what t i m e the m e d i c a t i o n s  taken  (c)  patient  knows t h e  effects  (d)  patient  knows t h e  possible side-effects  medications A low  should  level  zero to  of  of  the  medications of  taken  the  taken. knowledge  one a n s w e r .  is signified  by a k n o w l e d g e  of  A moderate  level  of  knowledge  knowledge of  two a n s w e r s .  A high  of  of  level  three  Routine  knowledge  to four  is s i g n i f i e d  is signified  by a  by a k n o w l e d g e  answers.  information:  information  regarding  m e d i c a t i o n s which who a t t e n d Additional  the  planned  information  is  routinely  d i a g n o s i s and  given to  patients  clinic.  teaching:  and t e a c h i n g r e g a r d i n g h i s d i a g n o s i s and  c o n s i s t s of  thirty-minute  the  Twenty-four-hour  patient  by t h e  d i s c u s s i o n w i t h the  period, during  a l s o encouraged to ask  that  patient's  outpatient  m e d i c a t i o n s g i v e n to This  the  researcher.  patient  which the  over a  patient  is  questions.  period:  twenty-four-hour  p r e c e d i n g the  period  interviewer's  of  time  visit  to  immediately the  patient's  home. VI. 1. patient  LIMITATIONS OF THE STUDY  The r e s u l t s  of  the  study are dependent  h o n e s t y and a c c u r a c y i n r e s p o n d i n g t o  upon  the  q u e s t i onna i r e . 2. patients  Because of  i n the  the  low s o c i o - e c o n o m i c s t a t u s  s t u d y , and t h e  geographic  limitation  of  the  that  24 they a l l  live  possible  to  i n the  same  large  generalize results  urban a r e a , to  the  it  general  is  not  population.  3. Most s t u d i e s a r e n e v e r c o m p l e t e l y f r e e o f extraneous v a r i a b l e s . Because of these limitations t h e r e can n e v e r be a b s o l u t e c e r t a i n t y t h a t t h e e f f e c t s p r o d u c e d i n an e x p e r i m e n t w o u l d h o l d t r u e f o r t h e ^ t a r g e t p o p u l a t i o n when t h e f i n d i n g s a r e g e n e r a l i z e d . 0  VII.  The a s s u m p t i o n was made t h a t p a t i e n t s  1. willing  to admit  assignment of  patients  would d i s t r i b u t e between the  Research," p . 205.  to medication  two  to  were  errors.  The a s s u m p t i o n was made t h a t t h e  2.  60  ASSUMPTIONS  control  any u n r e l i a b i l i t y  random  and e x p e r i m e n t a l of  responses  groups  randomly  groups.  E  ugene L e v i n e , " E x p e r i m e n t a l D e s i g n i n N u r s i n g N u r s i n g R e s e a r c h . V o l . I X , N o . 4 ( F a l l , 1960),  Chapter  4  METHODOLOGY I.  THE SAMPLE  The s a m p l e f r o m w h i c h d a t a were o b t a i n e d was drawn from a p o p u l a t i o n  of  clinic  urban h o s p i t a l .  at  a large  assigned to  patients  criteria  the  control  for  The m e d i c a l  were p e r u s e d i n o r d e r i n c l u s i o n i n the  were:  daily,  being ambulatory,  the  randomly  the  experimental  r e c o r d s of  the  t h o s e who met t h e  The c r i t e r i a  for  to  outpatient  living  at  criteria  the  sample  home, t a k i n g  participate. clinic  limited  The  eligibility  the  individual's  $150.00 p e r month p e r p e r s o n , w i t h  savings  amounting  to  the  population  c o n s i s t e d of p a t i e n t s  Therefore of a  years  digoxin  income t o  l e s s t h a n $1,000.00.  and  patients  c a r d i a c i l l n e s s , age f o r t y - f i v e  and w i l l i n g n e s s for  obtain  study.  a d i a g n o s i s of  and o v e r ,  scale  to  outpatient  a s s i g n i n g t h o s e who met  sample i n c l u s i o n , to  groups.  the  P a t i e n t s were  g r o u p s by a l t e r n a t e l y  the  for  who a t t e n d e d  sample  low s o c i o - e c o n o m i c  status. II.  THE BIOGRAPHICAL DATA  The p a t i e n t s the  study  were met  who met t h e  individually  25  criteria by t h e  for  inclusion  r e s e a r c h e r as  in  they  waited the  for  their  introduction  page 68.  After  interviewed the  appointments  is  contained  to  the  tively  the  biographical clinic.  is  contained  data  the  patient  of  was  cubicle  the b i o g r a p h i c a l A date f o r  home i n t e n t o f o u r t e e n  data  the  d a y s was  of form  visit  tenta-  agreed upon.  A copy of  THE PLANNED TEACHING  the  semi-structured  researcher followed  A p p e n d i x C , page 72. thirty-minute experimental discussion  in patient  interview  teaching  d i s c u s s i o n w i t h each p a t i e n t group.  A write-up  is contained  of  one s u c h  learning  situation  by i d e n t i f y i n g  behavior,  by c h o o s i n g a l t e r n a t i v e s  decisions  under the  instructed  i n the  guidance of large  use o f  in  the  in  the  teaching The teaching-  self-medication  and by m a k i n g t h e i r researcher.  own  Each  c a l e n d a r and a p e n c i l , and these  items f o r  when a m e d i c a t i o n had been t a k e n .  in  the  i n the  g o a l s of  which  is contained  i n A p p e n d i x D, page 75.  were e n c o u r a g e d t o p a r t i c i p a t e  was g i v e n a  guide  The same f o r m a t was f o l l o w e d  patients  patient  A copy  in Appendix A,  in a p r i v a t e  i n A p p e n d i x B, page 70.  patient's  doctors.  participate,  A copy o f  III.  the  patient  agreeing to  for  outpatient  to  w i t h the  indicating  daily  27  IV. Purpose of  the  Questionnaire  The o v e r a l l was t o  obtain  goal f o r  objective  between t h e  dependent  behavior  the  patient  in  variable  C o n s t r u c t i o n of  of  its  objective  of  relationship  self-medication variable  of  c o m p a r i s o n s were made groups,  the  and t h e  three  twenty-item  i n A p p e n d i x E , page  the  results  required  instrument,  this  was a v a i l a b l e .  a study  data  the  instrument  80.  Questionnaire  collection study  patient  A copy of  The measurement terms  about  and c o n t r o l  contained the  of  collection  independent  From t h e s e  h y p o t h e s e s were t e s t e d . is  data  information  experimental  questionnaire  the  home, and t h e  teaching.  between the  THE QUESTIONNAIRE  the  of  study  development  s i n c e none t h a t Some o f  the  in  of a data  c o u l d be a p p l i e d  the  items  by S c h w a r t z , H e n l e y , and Z e i t z  of  to  were b a s e d on  elderly  ambulatory  pati ents In  d e s i g n i n g the  questionnaire,  t i o n was g i v e n t o e l i c i t i n g the  self-medication  Other f a c t o r s involved charts  taken  in data  i n the  practices  of  into account  collection,  outpatient  'Schwartz, AmbuIatory P a t i e n t .  objective  the  clinic  the  primary  considera-  information patients  included  the  availability and t h e  regarding  in t h e i r  homes.  t i m e and  cost  of  expected  the  patients'  cooperation  H e n l e y , and Z e i t z , The E I d e r I y p. 3 0 7 .  28 by t h e p a t i e n t the  i n p r o d u c i n g the m e d i c a t i o n c o n t a i n e r s  interviewer  during  the  The s e q u e n c e o f permitted  a free-flow  was an o r d e r l y by t h e life  the  interviewer,  visit.  items  of  questions  for  a l l o w e d the  It  patient  was f e l t  possible bias  by h e l p i n g  questionnaire  to put  that  this  patient  pages.  rather  The c h a r t  completed while simplified were  included  data of  the In  the  the  than  interrogated.  on t h e  third  eliciting  data a n a l y s i s p r o c e s s . i n the  questionnaire  order  to e l i m i n a t e  responses to at  ease.  the  help the  The to  feel  c o n s i s t s of  three  interviewer  questions 3 to  13,  Q u e s t i o n s 14 t o  t o add t o  the  20  descriptive  p o s s i b l e b i a s by  or  control  interviewers, of  the  patient  group.  Questionnaire  The q u e s t i o n n a i r e were e a c h v i s i t e d order  It  c o n t a i n e d no i d e n t i f i c a t i o n  with regard to experimental of  his  study.  questionnaire  Pre-test  to  his  would a l s o  page, which the  responses to  received  d i g r e s s to  were u n r e l a t e d  in patient the  to  q u e s t i o n n a i r e was d e s i g n e d t o a l l o w t h e p a t i e n t comfortable  there  necessary information  e x p e r i e n c e s which f r e q u e n t l y  control  the  conversation which, although  p r o g r e s s i o n of  medication regimen. to  home  for  in t h e i r  to a d m i n i s t e r  the  was p r e - t e s t e d . homes t w i c e ,  tool.  p r e c i s i o n and r e l i a b i l i t y  of  patients  one week a p a r t ,  The w o r d i n g , the  Four  questions  relevancy, were  in  29 tested.^  The p a t i e n t s  2  re-administration therefore  of  responded with  the  revealed that  identical  questionnaire. reliable  data  Pre-testing  c o u l d be  A r e v i s i o n was made by d e l e t i n g questionnaire. medication  was p r i n t e d  unnecessary, at the  the  A question asking on t h e  since a l l  outpatient  obtained  pharmacy which containers.  Any d o u b t a s t o  willingness  p a r t of  the  patients  the  was d i s p e l l e d .  wi I I i n g I y p r o d u c e d t h e  medication  interviewer.  so b e f o r e  the  the  names on a I I m e d i c a t i o n  Some d i d  medication  were e v i d e n c e d , t h e  unaware o f  them.  The r e v i s e d  the  was f o u n d  to  their  to  the  be  medications  routinely  printed  cooperate  The f o u r  on  the  patients for  being asked.  the  They a n s w e r e d  Where e r r o r s  patients  questionnaire  name o f  containers  questions without h e s i t a t i o n .  obtained.  an item f r o m  container  patients  clinic  if  s c o r e s upon  in  self-  o f t e n seemed t o  was r e v i e w e d  by t h e  be  thesis  commi t t e e . The p a t i e n t s not  included  i n the  Administration In the  part  of  of  order the  who p a r t i c i p a t e d  in  the  pre-test  were  study.  the  Questionnaire  to attempt  to  control  for  possible  r e s e a r c h e r who a l s o m a n i p u l a t e d  bias  on  the  F a y e G . A b d e l l a h and Eugene L e v i n e , B e t t e r P a t i e n t Ca r e T h r o u g h N u r s i ng R e s e a r c h (New Y o r k : The Macmi I Ian Company, 1 9 6 5 ) , p . 3 2 1 . D £ i  experimental interviewers, other  variable one o f  a pharmacist,  his  were n o t the  visit  clinic  each a d m i n i s t e r e d f i v e patient's  to the  home, t e n  clinic.  obtained  or  by t h e s e  the  control  by the  outside  nurse and  the  questionnaires.  to f o u r t e e n  days  interviewers  patient  group.  interviewers  responses obtained remaining t h i r t y  the  two  The o u t s i d e  i n f o r m e d as t o w h e t h e r  experimental  setting,  whom was a r e g i s t e r e d  T h i s was done i n t h e after  i n the  was a s s i g n e d t o  P a t i e n t responses  were c o r r e l a t e d w i t h  r e s e a r c h e r who v i s i t e d  study p a t i e n t s  in t h e i r  patient  the  homes, when  the  d a t a were a n a l y z e d .  see the the  D u r i n g the  home i n t e r v i e w  containers  of  patient's  w i t h the  medical  to  record at  impugn g u i l t  l a b e l s to  p h y s i c i a n ' s orders  The q u e s t i o n n a i r e as not  interviewer  m e d i c a t i o n s , and w h i l e  c o n v e r s a t i o n , checked the  instructions  the  if  the  carrying  compare  was a d m i n i s t e r e d  to  on  these  taken from  outpatient  errors  asked  the  clinic. i n s u c h a way so  in s e l f - m e d i c a t i o n  were  made. R e l i a b i l i t y , V a l i d i t y and P r a c t i c a b i l i t y of the Q u e s t i onna i re "A measure i s reproducible."^ patient naire  is  will  reliable  Reliability  respond w i t h the  re-administered.  Levine,  It  if is  it the  is  consistently  degree to which a  same s c o r e s when a q u e s t i o n i s a measure o f a  "Experimental  Design,"  p.  208.  tool's  31 stability patients on b o t h  and c o n s i s t e n c y . ^ in  the  reliability  the  pre-test  first of  really  tool  supposed to  and v o i d s  were  identical  Therefore  question,  "Does the  instrument  supposed to measure?" this  study  in patient  did  The  reveal  knowledge,  errors which  in  it  was  measure.  Levine states statistical  is  designed for  seIf-medication  questionnaire  four  was deemed h i g h .  answers the  measure what i t  questionnaire  the  and s e c o n d a d m i n i s t r a t i o n .  the  Validity  of  Responses from the  4  tests  validity  is  related  show s i g n i f i c a n t  to  results,  relevance. do t h e s e  If  results  65 actually is  felt  have a p r a c t i c a l  in real  t h a t a s t u d y whose d a t a - g a t h e r i n g  a significantly are  significance  higher  number o f  b e i n g made by p a t i e n t s ,  errors  tool  in  where t h e s e  life? reveals  patients  teaching about  their  practical  in real  life.  Patient  nurse.  Teaching a p a t i e n t  about  necessarily a d i f f i c u l t  task.  function  of  medications  the  i s not  in seIf-medication the  of  digoxin  have  medications, teaching  can r e s u l t  that  self-medication  been e x p o s e d t o value  It  in real  is  not of  is a his Errors harm  to  p a t i e n t as W a l t o n and G a z e s p o i n t o u t when t h e y w r i t e : I n a d e q u a t e dosage commonly i s f o l l o w e d by t h e r e t u r n of the c o n d i t i o n s of h e a r t f a i l u r e . E x c e s s i v e dosage i s f o l l o w e d by t o x i c e f f e c t s w i t h a r r h y t h m i a s and as a f i n a l stage, heart standsti I I . ° °  64 A b d e l l a h and L e v i n e , o p . c i t . , ^^Levine, loc. c i t . W a l t o n and G a z e s , " C a r d i a c  p.  322.  Glycosides  II,"  p.  780.  And J a n k o w s k i s a y s , therapeutic narrow, With  " O b v i o u s l y , the  dose a n d t h e  toxic  dose o f  compared w i t h most d r u g s  regard to  diuretics,  digitalis  i n common use  Grollman  The p o t e n t , commonly limited in a c t i o n . This patients with congestive o v e r u s e o f d i u r e t i c s may prove f a t a I  margin between  the  is  quite  today."^7  writes:  used d i u r e t i c s are not s e l f i s p a r t i c u l a r l y true in h e a r t f a i l u r e , . . . where i n c r e a s e d i s a b i l i t y and even  According to F i s h e r : . . . the s i m p l e p r e c a u t i o n of r a n d o m i z a t i o n w i l l s u f f i c e t o g u a r a n t e e the v a l i d i t y of a t e s t of s i g n i f i c a n c e , by w h i c h t h e r e s u l t o f t h e e x p e r i m e n t i s t o be j u d g e d . 6 9 The s a m p l e p o p u l a t i o n i n t o two g r o u p s . tests  of  in this  The a b o v e s t a t e m e n t  s i g n i f i c a n c e were The p r a c t i c a b i l i t y  reasonableness t i o n . 70  patient  in c o s t ,  twenty  responses.  items  to  would  imply  that  the  valid. of a t o o l  i n t i m e and  The q u e s t i o n n a i r e  r e a d i n g the  s t u d y was r a n d o m l y a s s i g n e d  i s m e a s u r e d by in ease of  administra-  was r e a d i l y a d m i n i s t e r e d the  patient  its  by  and r e c o r d i n g  T h i s c o u l d be done i n  less than  the  twenty  ^ N o r m a n W. J a n k o w s k i , " D i g i t a l i s : I N e v e r Know Where I S t a n d W i t h I t , " P a t i e n t C a r e C I i n i caI C o n c e p t s (March 1 5 , 1 9 7 0 ) , p. 8 9 . Nursing,  ^ A r t h u r Grollman, " D i u r e t i c s , " American Journal V o l . L X V , N o . 1 ( J a n u a r y , 1965), p . 89.  London:  ^ 9 R . A . F i s h e r , The De s i gn o f E x p e r i m e n t s O l i v e r and B o y d , 1 9 6 0 ) , p . 2 1 .  (7th  of  ed.;  ^ ° V i v i a n Wood, " U n d e r s t a n d i n g P s y c h o m e t r i c T e s t s , " The C a n a d i a n N u r s e . V o l . L X I , N o . 4 ( A p r i l , 1965), p . 2 8 2 .  33 minutes. cost of  The c o s t travel  to  The s i m p l i f i e d questionnaire for  the  of  the forms  was n o m i n a l .  the  patient's  home must a l s o be c o n s i d e r e d .  method o f makes i t  "An activity  is  the  objectivity  and p r a c t i c a b l e  of  characteristic  measurement." purpose the  tool  this  study  chi-square  test  of  difference  between the  two g r o u p s  continuity  the  results.  number and t y p e in  patients.  the  Numbers a r e  7 2  s i g n i f i c a n c e was used t o  difference of  of  data  enhances  d a t a were d i s c r e t e  was a p p l i e d where  were p e r f o r m e d In  the  scientific  quantification  language.  In  and t h e  since  of a I I  Having numerical  7 1  interpretation  l e s s ambiguous than  cance,  an e f f i c i e n t  the  METHOD OF DATA ANALYSIS  important  serves a useful  t he  d a t a a n a l y s i s on page 3 o f  researcher. V.  errors,  The t i m e and  of  l e v e l s of Yates'  values.  The  determine  th e  self-medication  knowledge  correction  indicated. ^ 7  between  for  The  computations  manually.  order  to  perform  statistical  h y p o t h e s e s were s t a t e d  in  the  tests null  of  signifi-  hypothesis  ' ' W a l t e r R. F u c h s , C y b e r n e t i cs f o r t h e Modern Mi nd (New Y o r k : The M a c m i l l a n Company, 1 9 7 1 ) , p. 58. 72  L e  v i n e , o p . c i t . , p. 206. ^ D o n a l d R. S h u p e , "On t h e Use o f C h i - S q u a r e N u r s i n g R e s e a r c h , " N u r s i ng R e s e a r c h , V o l . X V I , N o . 3 (Summer, 1 9 6 7 ) , p . 282.  in  form.  The  .05  statistically .05  level  level  of  significance  significant.  was made b e f o r e  Some o f  the  T a b l e s and g r a p h s  data  was a c c e p t e d a s  The d e c i s i o n t o a c c e p t the  study  the  was b e g u n .  were a l s o a n a l y z e d d e s c r i p t i v e I  were drawn t o  illustrate  comparisons.  Chapter 5 ANALYSIS OF THE DATA I. A total patients  f o r t y a m b u l a t o r y male and f e m a l e c a r d i a c  comprised the  initially for  of  THE STUDY POPULATION  study sample.  agreed to p a r t i c i p a t e  Forty-four  i n the  s t u d y when t h e y came  c l i n i c a p p o i n t m e n t s on T u e s d a y m o r n i n g s d u r i n g  months o f  N o v e m b e r , D e c e m b e r , and J a n u a r y .  subsequently  not  experimental  g r o u p was h o s p i t a l i z e d b e f o r e  i n c l u d e d i n the  study.  v i s i t e d a t h i s home t e n t o f o u r t e e n the  clinic.  A n o t h e r man f r o m t h i s  t h e s t u d y b e c a u s e t h e home v i s i t family his  patients  the  F o u r were  One man f r o m  the  he c o u l d be  days a f t e r  visiting  g r o u p was o m i t t e d  from  revealed that a close  member a d m i n i s t e r e d h i s m e d i c a t i o n s and a l s o became  spokesman d u r i n g t h e  interview.  In t h e  control  one man was a l s o h o s p i t a l i z e d , and a woman who had s t a t e d she was w i l l i n g refused to permit She was t h e  if  to  to  i n the visit  initially  study,  her at  from the  later  h e r home.  refuse to p a r t i c i p a t e ,  was t o l d he c o u l d w i t h d r a w  although  study  at  he s o d e s i r e d .  D u r i n g the outpatient  interviewer  only patient  each p a t i e n t any t i m e  the  to p a r t i c i p a t e  group  initial  patient  interview  in  c l i n i c , an e m p h a s i s on t h e p a t i e n t ' s  35  the medications  was a v o i d e d by e x p r e s s i n g an i n t e r e s t getting along at  home.  help to a v o i d b i a s biographical  i n the  data f o r m ,  with patients  in the  been a s s i g n e d t o thirty-minute researcher  the  after  obtained after  the  was f e l t study.  After  no f u r t h e r  control  that  this  approach  s e e i n g the  the  c o m p l e t i o n of  patients  biographical  the  Those p a t i e n t s  group,  returned  patients  list  data f o r m .  of  were t a k i n g  e i g h t e e n from each group,  study.  and a l l  other  contained  the  medications prescribed for  i n A p p e n d i x F , page 84.  analgesics,  less  s o m n e r i f i c s and  p r e s c r i b e d as p . r . n .  to of  i n some Only  A M of  Thirty-six  were a l s o t a k i n g a  of  but  in  list  long-standing.  digoxin.  A list  were  doctor,  In many i n s t a n c e s t h i s  The two most commonly p r e s c r i b e d d i u r e t i c s Hydrochlorothiazide.  a  prescribed medications  m e d i c a t i o n s were c o n s i d e r e d i n the patients  for  i n both groups  had been s e e n by the  c a s e s c h a n g e s were made i n o r d e r s o f  forty  who had  the  m e d i c a t i o n s was u n c h a n g e d f r o m p r e v i o u s o r d e r s ,  oral  the  doctor.  r e c o r d s of  to t r a n s c r i b e  would  c o n v e r s a t i o n was h e l d  group.  experimental  i n how he was  planned teaching d i s c u s s i o n with  The m e d i c a l  order  It  only  the  patients,  diuretic.  were L a s i x  common  and  diuretics  these p a t i e n t s  is  Nitroglycerine,  l a x a t i v e s were  o r d e r s and were n o t  routinely  included  in  the  study. A p h a r m a c y was Patients  obtained t h e i r  The names o f  the  located  i n the  outpatient  m e d i c a t i o n s here w i t h o u t  d r u g s as w e l l  clinic. cost.  a s amounts and t i m e s  to  be  37 t a k e n were c l e a r l y p r i n t e d the  interviewers  to  on t h e  check the  containers.  This  containers during  enabled  t h e home  visit. The p a t i e n t s  i n the  willingly  to t a l k  doctors.  The t i m e  to  Most t a l k e d  them.  w i t h the  their  freely  the  the  three  patients.  home v i s i t  information following  the  their  come t o  seem t o be a c o n c e r n their  cardiac  conditions  them and  was e n c o u n t e r e d .  interview  patients*  took  place  health,  the  questionnaire.  to  the  It  the  visit  their  seemed t h a t where the  patients  appeared  l e a v e , and, t h a n k e d h e r f o r  by did  was  to  freely,  medications errors themselves  had o c c u r r e d , e x c e p t  Almost every p a t i e n t  interviewer  eliciting  They t a l k e d  clinic,  interviewer,  n o t aware t h a t e r r o r s  During  Most p a t i e n t s  purpose of  outpatient  experiences.  homes  self-medication behavior  self-medication behavior.  omissions.  t o see t h e  their  were a c c e p t e d i n t o the  r e c o g n i z e t h a t the  became a p p a r e n t  case of  the  twenty-item  life  were o f t e n  interviewers  a free-flow  c h e c k on t h e i r  and o t h e r  seeing  l e a r n i n g more a b o u t  O n l y one r e f u s a l  about  not appear to  about  in  about  returned  medications.  All of  group  researcher after  i n v o l v e d d i d not  and a p p e a r e d i n t e r e s t e d about  experimental  in  the  reluctant having  visit.  II. Details experimental  of  the  SUMMARY OF THE DATA background of  and c o n t r o l  patients  in  the  g r o u p s a r e shown i n T a b l e s 1 and 2.  38  Table 1 S e x , A g e , L i v i n g A r r a n g e m e n t and T o t a l Number of M e d i c a t i o n s of P a t i e n t s in the E x p e r i m e n t a l Group Pati ent  Sex  1 2  M M M M F M M M F M F M M M M F F M M M  3  4 5 6 7 8 9  10  11  12  13  14  15  16  17  18  19  20  Age  67  64  66 64  74 62 65 66 78  67 66 77 61 69 69 85 59 60 80  89  L i vi ng arrangement*  T o t a l number of m e d i c a t i o n s  A A S A  3 3  4 2  0  3  4  A A S 0 A S 0 A A 0 A A A A A  X = 69.4 * A = l i v i n g a I one S = l i v i n g w i t h spouse 0 = l i v i n g with other a d u l t s .  3  5 4 2 3  2 2 3 3 3  7  3  2 3  X =  3.2  39  Table Sex,  P a t i ent  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16  17 18  19 20  2  A g e , L i v i n g A r r a n g e m e n t and T o t a l Number of M e d i c a t i o n s of P a t i e n t s i n the C o n t r o l Group Sex  F M M M M M F M F F M F M: M F F M F F M  Age  65  59 80 78 88 82 71 56  75 77 61  82 72 67  82 79 53 58 69 71  L i v i ng arrangement*  T o t a I number of m e d i c a t i o n s  S A 0 A 0 0 A A A S S 0 0 A 0 S S A A A  X = 71 . 3 * A = I i v i n g a I one S = l i v i n g wi t h s p o u s e 0 = I i v i ng wi t h o t h e r a d u l t s .  3 5 3 3 3 4 3 4 3 4 5 2 2 3 3 3 2 3 8 4 X =  3.5  40 In  the  experimental  female.  group of  The c o n t r o l  twenty p a t i e n t s ,  group of  twenty p a t i e n t s  n i n e f e m a l e s and e l e v e n m a l e s . experimental of  the  In alone, married  six  children  or other  lived with married  the e x p e r i m e n t a l  thirteen  adults.  In t h e  g r o u p was 3 . 2 ,  while  other  of  both  the  g r o u p s a r e shown i n F i g u r e 1 .  patient  level  effects. three of  between p a t i e n t of  errors  i n the  of  spouses and The in  control  group  self-medication medications,  experimental The f i g u r e  and  (which  represent forty  shows t h e  15 p e r c e n t  patients  period,  the  r e p r e s e n t 85 p e r c e n t o f In o t h e r  l  of  the  studied) in a  and  errors  in  number  twenty-four-hour  made by t h e  •!  of  self-  entire  m e d i c a t i o n s the e x p e r i m e n t a l  •  their  total  g r o u p made s e v e n t e e n e r r o r s  all  and  inverse  g r o u p made a t o t a l  d i g o x i n and d i u r e t i c s control  and  control  self-medication errors  m e d i c a t i o n of  population).  group,  d i g o x i n and d i u r e t i c s ,  experimental  made by a l l  while  adults.  with  k n o w l e d g e a b o u t h i s m e d i c a t i o n s and  The e n t i r e  errors  control  and o t h e r  knowledge of  m e d i c a t i o n s , of  relationship  lived  patient.  i n d i g o x i n and d i u r e t i c s , level  lived  m e d i c a t i o n s p r e s c r i b e d per p a t i e n t  The p e r c e n t a g e d i s t r i b u t i o n  the a v e r a g e  the  patients  lived with their  c h i l d r e n or o t h e r  was 3 . 5 m e d i c a t i o n s p e r  errors  of  t h e a v e r a g e age  spouses and f o u r  lived alone, five  a v e r a g e number o f  it  group,  lived with t h e i r  nine p a t i e n t s  consisted  g r o u p was 7 1 . 3 y e a r s .  the e x p e r i m e n t a l  three  were  The a v e r a g e age o f  group was 6 9 . 4 y e a r s , w h i l e  control  five  (which study group  41 made a t o t a l errors  of  six  made by t h e the  errors  (which  forty patients  period,  while  control  percent  of a I I e r r o r s  is 27.3 percent  of  studied)  the  during  g r o u p made s i x t e e n e r r o r s  made by t h e  entire  study  aI I same  (or  72.7  population.  1  Errors in d i gox i n and d i u r e t i cs  A v e r a ge I eve I o f know l e d g e of d i g o x i n and d i u r e t i cs  Errors other me d i ca tions  Average Ie veI o f know ledge of other medi c a t i ons  Legend: E x p e r i m e n t a l group C o n t r o l group F i gure 1 Percentage D i s t r i b u t i o n of S e l f - M e d i c a t i o n E r r o r s i n D i g o x i n and D i u r e t i c s , and O t h e r M e d i c a t i o n s , and A v e r a g e L e v e l o f K n o w l e d g e o f D i g o x i n and D i u r e t i c s , and O t h e r M e d i c a t i o n s , o f B o t h E x p e r i m e n t a l and C o n t r o l G r o u p s The p a t i e n t ' s the a s k i n g of Therefore, four  the  four  level  questions  patient  k n o w l e d g e was e s t a b l i s h e d  concerning his  who knew t h e  q u e s t i o n s w o u l d have a  (  of  level  of  correct  by  medications. answers to  knowledge  of 4 .  all The  42 average  level  of  knowledge of  experimental  group was 2 . 7  the  possible  level  the  control  of  the  group  of it  d i g o x i n and d i u r e t i c s  (which  knowledge of  other  g r o u p was 2 . 5  knowledge of  it  was 1.1  (or  i s 69.1  100 p e r c e n t )  The a v e r a g e  30.9 percent  percent while of  diuretics  level  of  the  for  percent  of  possible control  types of  medications other  made by b o t h  the  of  experimental  p o s s i b l e 100  The number and p e r c e n t a g e o f medication errors  of  for  the  while  represents 30.8  m e d i c a t i o n s t a k e n by t h e  (which  of  100 p e r c e n t )  (which  p o s s i b l e 100 p e r c e n t ) .  the  represents 69.2 percent  knowledge of was 1.2  of  level  group  percent).  self-  than d i g o x i n  g r o u p s a r e shown i n T a b l e  and  3.  Table 3 Number and P e r c e n t a g e o f T y p e s o f S e l f - M e d i c a t i o n E r r o r s i n M e d i c a t i o n s O t h e r Than D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s E x p e r i m e n t a l group N = 20  Type of error  Omi s s i on Not p r e s c r i b e d Improper time I n c o r r e c t dosage Tota I  The t y p e  of  C o n t r o l group N = 20  Number of errors  Pe r c e n t a g e of t o t a I errors  Number of errors  Percentage of t o t a I errors  1 3 1 1  16.6 50.0 16.7 16.7  4 2 7 3  25.0 12.5 43.7 18.8  6  100.0  16  self-medication error  was made by most p a t i e n t s  in the  of  other  1 00.0  medications  experimental  group was  which  t a k i n g a m e d i c a t i o n not control  g r o u p most p a t i e n t s  medications at errors  in  the  incorrect of  errors  omission.  of  prescriptions  dosage.  the  doctor  to  (seventeen e r r o r s )  control  g r o u p made  d i g o x i n and  d i g o x i n and other  (Q.I.D.), orders the  diuretics  medications  m e d i c i n e s as i n  patients  i n the  r e g a r d t o age g r o u p ,  (sixteen  a s many  errors  self-medication  total  i n b o t h g r o u p s who made medication regimen,  and mean number o f  i n e a c h age g r o u p , a r e  errors  per p a t i e n t  m e d i c a t i o n r e g i m e n , were made by t h e 61-70 made by t h e  under s i x t y control  d i d make e r r o r s .  per  self-  with patient  shown i n T a b l e 4.  b o t h g r o u p s , most e r r o r s  In t h e  often  diuretics.  medication errors  age.  were  t i m e s a day  g r o u p made t w i c e  other  The number o f  patients  four  g r o u p made a p p r o x i m a t e l y  as i n t a k i n g  The e x p e r i m e n t a l  the e r r o r s  group made  were u s u a l l y o n l y d a i l y  in taking  i n s e l f - m e d i c a t i o n of  of  the  B o t h g r o u p s made few  be t a k e n f o u r  control  same number o f e r r o r s  In  the  c a t e g o r y o f m e d i c a t i o n s , some common  However, the  errors).  In  taking  The e x p e r i m e n t a l  d i g o x i n and d i u r e t i c s  (O.D.).  of  s u c h as p o t a s s i u m p r e p a r a t i o n s  o r d e r e d by t h e  of  time.  omission while  In t h i s  doctor.  made t h e e r r o r  improper  one e r r o r  while  p r e s c r i b e d by t h e  experimental  age g r o u p .  In e a c h o f  patients the  four  total None  g r o u p were made by  y e a r s o f age o r o v e r e i g h t y group,  i n the  years  i n t h e s e two age age g r o u p s  the  of groups  Table 4 Number o f P a t i e n t s i n B o t h G r o u p s who Made S e l f - M e d i c a t i o n E r r o r s i n t h e T o t a l M e d i c a t i o n R e g i m e n , w i t h R e g a r d t o Age G r o u p , and Mean Number o f E r r o r s per P a t i e n t i n E a c h Age Group Group N = 20  Experimental  Control  Group N = 20  Age Group  Number o f patients  Number of errors  Mean number of e r r o r s per p a t i e n t  Number o f patients  50-60  2  0  0  4  8  2.00  61-70  12  7  0.55  4  9  2.50  71 - 8 0  4  2  0.50  8  12  1 .25  81 - 9 0  2  0  0  4  4  1 .00  20  9  20  33  Total  X = 0.52  Number of errors  Mean number of e r r o r s per p a t i e n t .  X =  1.68  45 experimental  g r o u p made f e w e r a v e r a g e e r r o r s  than d i d the  control  in the  and c o n t r o l  total  total  Most e r r o r s  m e d i c a t i o n regimen  patients percent patients  who of  who  self-medication  errors  living  both  experimental  arrangements,  in s e I f - m e d i c a t i o n  in  In  the e x p e r i m e n t a l  made by t h e  lived alone.  group  They made f i v e Only  of  the  group.  made by t h e  experimental  g r o u p were made by p a t i e n t s  were m a r r i e d and  lived with t h e i r  percent  number e r r o r s  who  lived with married  I I. I p e r c e n t  spouses,  while  made were made by  children  55.5  total  made by t h i s  total  the  g r o u p were made by  nine e r r o r s  of  is  i n b o t h g r o u p s were made by  lived alone.  the  of  m e d i c a t i o n regimen of  groups w i t h regard to  shown i n F i g u r e 2 .  patient  group.  The p e r c e n t a g e d i s t r i b u t i o n errors  per  or o t h e r  of  of errors  who  33.4 patients  adults.  i_  o  i_  i_ OJ  HO  CD CD CO -H  c CD  o l_  CD  Legend:  yy ' y / 'yy Vy A I one  E x p e r i m e n t a l group C o n t r o l group  Spouse  Figure  Others  2  P e r c e n t a g e D i s t r i b u t i o n of S e l f - M e d i c a t i o n E r r o r s i n the T o t a l M e d i c a t i o n Regimen o f B o t h E x p e r i m e n t a l and C o n t r o l Groups w i t h Regard to L i v i n g Arrangements  In t h e  control  group,  those p a t i e n t s  made 5 1 . 5 p e r c e n t o f a I I e r r o r s made e i g h t e e n o f the  control  the t o t a l  group.  of  made by t h e  thirty-three  Those p a t i e n t s  s p o u s e s made 2 4 . 4 p e r c e n t o f a l l group w h i l e who  24.1  percent of a l l  the  patient  in s e l f - m e d i c a t i o n e r r o r s control  group.  t y p e s of  They  their  e r r o r s made by t h e  control  e r r o r s were made by  patients  adults.  was n o t a s i g n i f i c a n t  in either  alone  e r r o r s made by  factor  the e x p e r i m e n t a l  M a l e s and f e m a l e s made s i m i l a r  or  the  numbers and  errors. Patients  prescribed for  who had a l a r g e number o f  them by t h e i r  than did p a t i e n t s was t r u e  with only  nurses  i n the  two or t h r e e  weekly  injections  were n o t  community.  visited  Two p a t i e n t s  f r o m a community  taking  they would  like  I forget."  their to  This  groups.  by p u b l i c  health  stated they  received  nurse. g i v e n by p a t i e n t s  t o t a k e m e d i c a t i o n s w a s , "I  s o m e t h i n g and t h e n  errors  medications.  and c o n t r o l  The r e a s o n most f r e q u e n t l y forgetting  medications  p h y s i c i a n s made no more  in both the e x p e r i m e n t a l Most p a t i e n t s  dislike  group.  who l i v e d w i t h  l i v e d w i t h m a r r i e d c h i l d r e n or o t h e r The sex o f  who l i v e d  get  for  busy d o i n g  They d i d n o t a p p e a r  to  m e d i c a t i o n s , b u t many p a t i e n t s  know more a b o u t t h e e f f e c t s  of  stated  the  medi c a t i o n s . In summary, p a t i e n t s self-medication errors and t h e y had a  lower  i n the  than those  level  of  control  g r o u p made more  in the e x p e r i m e n t a l  knowledge about  their  group  47  medications.  In b o t h g r o u p s ,  who made t h e  most e r r o r s  g r o u p , and t h o s e who In  order  researcher, of  to  the  the  the  interviewed  percent)  and d i u r e t i c s . interviewed patients  total  by t h e  the  fourteen  of  percent)  made e r r o r s .  six  of  the  percent)  made  of  0  were  patients digoxin  group  None o f  were  these  errors. the  researcher  Nine of  Four of  interviewed  these p a t i e n t s  (64.29  interviewers  visited  these p a t i e n t s  (66.67  ANALYSIS IN RELATION TO HYPOTHESIS  The f i r s t There  is  by members o f the  the  s t u d y was d e s i g n e d t o  no s i g n i f i c a n t  test  three  difference  in the  made i n a t w e n t y - f o u r - h o u r  experimental  control  I  h y p o t h e s i s was:  self-medication errors  members o f  these  in t h i s  interviewers.  The two o u t s i d e  The e x p e r i m e n t a l  H  Three of  group  that  errors.  III.  hypotheses.  were  T a b l e 5 shows  in s e l f - m e d i c a t i o n of  group,  20 patients.  variable  experimental  in the e x p e r i m e n t a l  the 2 0 p a t i e n t s .  made  in the  the 2 0 p a t i e n t s  outside  control  independent  interviewers.  made e r r o r s Four of  the  s a m p l e home i n t e r v i e w s  researcher.  (0 percent) In  patients  20 patients  by t h e  6 1 - 7 0 y e a r age  p o s s i b l e b i a s of  who a l s o m a n i p u l a t e d t h e  c o n d u c t e d by two o u t s i d e  (18.75  in the  patients  alone.  check f o r  one f o u r t h o f  s i x t e e n of  two c a t e g o r i e s o f  were t h o s e  lived  planned t e a c h i n g of  group,  the  group.  period  g r o u p a s compared w i t h The c h i - s q u a r e t e s t  number  of  Table 5 Number and P e r c e n t a g e o f P a t i e n t s i n B o t h G r o u p s Who Made S e l f - M e d i c a t i o n E r r o r s i n D i g o x i n and D i u r e t i c s a s E v i d e n c e d by t h e Three I n t e r v i e w e r s Experimental I n t e r v i ewer  Researcher O u t s i de i n t e r v i ewers  Number i nterviewed  Group N =  Number who made e r r o r s  C o n t r o I ' Group"N =  20  P e r c e n t a ge who made errors  16  3  18.75  4  0  0  Number i n t e r v i ewed  Number who made e r r o r s  20  Percentage who made . errors-  14  9  64.29  6  4  66.67  CO  49 employing a 2 x 3 contingency table  significance correction of  errors  for to  between the  continuity  determine number o f  as compared w i t h t h e is  contained  applied  was a p p l i e d t o  the  s i g n i f i c a n c e of  errors control  made by t h e group.  hypothesis Table  Yates*  d a t a on number  the  difference  experimental  group  The s t a t i s t i c a l  86.  i n A p p e n d i x G , page  in t e s t i n g  the  and  This formula  -  formula  was a l s o  III. 6  Number o f S e I f - M e d i c a t i o n E r r o r s o f D i g o x i n and D i u r e t i c s Made P e r P a t i e n t by B o t h G r o u p s Experimental  Number o f e r r o r s per p a t i e n t 2 1 0 T o t a l number of p a t i e n t s N = 40 7.72  OC = l  group  Control  0 3 17  4 9 7  20  20  permitted  the  . 0 5 I eve I.  the  number o f  made by t h e  the r e j e c t i o n  of  the  self-medication errors and c o n t r o l  This  null hypothesis  T h e r e was a s i g n i f i c a n t  experimental  .  d.f. = 2 P < .05  A c h i - s q u a r e v a l u e o f 7 . 7 2 was o b t a i n e d . result  group  of  difference d i g o x i n and  groups.  at  between diuretics  50 IV.  ANALYSIS IN RELATION TO HYPOTHESIS  The s e c o n d h y p o t h e s i s H of  There  0  is  self-medication  by members o f members o f  the  the  was:  no s i g n i f i c a n t  errors  difference  i n the  type  made i n a t w e n t y - f o u r - h o u r  experimental  control  II  g r o u p as compared  period  with  groups. Table 7  A.  Number o f S e l f - M e d i c a t i o n E r r o r s o f T a k i n g N o n - P r e s c r i p t i o n M e d i c a t i o n Made by B o t h Groups  Non-prescription  error  Experimental  Yes No Total  number o f  patients  N = 40 % = 1 .40 The c h i - s q u a r e t e s t  of  table  to  the  on a I I f o u r  of  patients.  and c o r r e c t i o n types  The s t a t i s t i c a l  2  1 19  18  20  20  of  for  continuity  errors  formula  was a p p l i e d  made by b o t h  is  contained  groups  in  G , page 8 6 . A chi-square  result  did  not  at  .05  level.  the  group  s i g n i f i c a n c e employing a 2 x 2  contingency  Appendix  Control  d.f. = 1 p^ .05  z  data  group  between t h e  value  p e r m i t the  of  1.40  rejection  was o b t a i n e d . of  the  T h e r e was no s i g n i f i c a n t  number o f  errors  of  taking  a  null  This hypothesis  difference  non-prescribed  51 m e d i c a t i o n made by t h e the  control  experimental  g r o u p a s compared  with  group. Table 8  B.  Number o f E r r o r s o f O m i s s i o n i n S e I f - M e d i c a t i o n D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s  Error  of  omission  Experimental  Yes No Total  number  of  patients  N = 40 %* = 4 . 9 0  o m i s s i o n of  digoxin  6 14  20  20  group  = 1 <.05  difference  and d i u r e t i c s  g r o u p as compared w i t h t h e  Control  0 20  d.f. p  T h e r e was a s i g n i f i c a n t  group  of  i n number o f made by t h e  control  errors  of  experimental  group.  Table 9 C.  Number o f E r r o r s o f I m p r o p e r o f D i g o x i n and D i u r e t i c s  Error  of  improper  time  Yes No Total  number o f  patients  N = 40 0t = 1 .-41 a  Time i n S e I f - M e d i c a t i o n Made by B o t h G r o u p s  E x p e r i m e n t a l group  Control  2 18  6 14  20  20  d.f. = 1 P > .05  group  52 T h e r e was no s i g n i f i c a n t errors  of  taking  made by t h e  difference  between t h e  d i g o x i n and d i u r e t i c s  experimental  at  the  number  of  improper  g r o u p as compared w i t h t h e  time  control  group. Table D.  10  Number o f E r r o r s o f I n c o r r e c t Dosage i n S e l f - M e d i c a t i o n o f D i g o x i n and D i u r e t i c s Made by B o t h G r o u p s  Error  of  incorrect  dosage  Experimental  Yes No T o t a I number o f  patients  N = 40  T h e r e was no errors  of  Control  group  0 20  3 17  20  20  d.f. = 1 P > .05  significant difference  incorrect  the e x p e r i m e n t a l V.  group  dosage of  between  t h e number  d i g o x i n and d i u r e t i c s  g r o u p as compared w i t h t h e  control  ANALYSIS IN RELATION TO HYPOTHESIS  of  made by group.  III  The t h i r d h y p o t h e s i s w a s : H of  Q  knowledge of  members o f of  There  the  the  control  is  no s i g n i f i c a n t  seIf-medication experimental group.  of  difference  i n the  level  d i g o x i n and d i u r e t i c s ,  g r o u p as compared w i t h members  of  53 Tab le 11 Level  Level  of  of  Knowledge o f S e l f - M e d i c a t i o n o f Di gox i n and D i u r e t i c s o f B o t h G r o u p s E x p e r i m e n t a l group  knowledge  Low Moderate High Total  number o f  patients  N = 40 11.66  T h e r e was a h i g h l y  significant  s e l f - m e d i c a t i o n of  the e x p e r i m e n t a l VI.  and c o n t r o l  i n the  number o f  of  of  data  groups of  difference  of  d i g o x i n and d i u r e t i c s ,  of  control  revealed that a  e x i s t e d between the ambulatory  cardiac  group.  fixed  level  of  level.  were t h e r e f o r e  patients, and the  T h i s was .05 or  better  The p a t i e n t s fewer  k n o w l e d g e was  i n c o m p a r i s o n w i t h the  I and I I I  experi-  p e r i o d , and i n  g r o u p made s i g n i f i c a n t l y  s e l f - m e d i c a t i o n and t h e i r  statisti-  in digoxin  these m e d i c a t i o n s .  s i g n i f i c a n c e as the  Hypotheses  i n the  by c h i - s q u a r e a n a l y s i s , u s i n g t h e  higher,  ..  level  self-medication errors  knowledge about  the e x p e r i m e n t a l  cantly  20  made i n a t w e n t y - f o u r - h o u r  determined level  the  difference  mental  level  20  SUMMARY OF RESULTS OF DATA ANALYSIS  significant  diuretics  14 4 2  g r o u p as compared w i t h t h e  E x a m i n a t i o n of cally  3 5 12  group  d.f. = 2 p < .01  y?=  knowledge of  Control  control  rejected.  errors  in in  signifi-  group.  The d i f f e r e n c e drugs,  in errors  t i m e and dosage was n o t  although  the  these three  experimental types.  significant  was t h e e r r o r  of  II  was r e j e c t e d  and D.  omission.  non-prescribed significant,  g r o u p d i d make f e w e r e r r o r s of e r r o r  difference  of  of  w h i c h showed a  between the  S i g n i f i c a n t l y fewer  g r o u p made e r r o r s only  taking  statistically  The o n l y t y p e  statistically  the e x p e r i m e n t a l  of  omission.  two  groups  patients  in  Hypothesis  i n p a r t B and a c c e p t e d i n p a r t s A , C ,  Chapter  6  SUMMARY, IMPLICATIONS FOR NURSING P R A C T I C E , AND RECOMMENDATIONS FOR FURTHER STUDY I.  SUMMARY  This experimental effect  of  p l a n n e d t e a c h i n g on t h e  of ambulatory years.  s t u d y was d e s i g n e d t o e v a l u a t e  cardiac patients  These p a t i e n t s  except four  over  were a l l  were a l s o t a k i n g  taking  at  large h o s p i t a l  in western Canada.  socio-economic  level  our  t h e age o f  They  information  group,  during  society.  and an e x p e r i m e n t a l teaching  to  errors  group,  regarding  their  A review of  the  i n c i d e n c e of  The t o t a l  of  o u t p a t i ent  the  to  literature  patients  usual  n u r s e ; and t h e  role  of  clinic, planned  researcher.  medical  relation  regimen  homes; t h e the  low  routine  was c o n d u c t e d i n  in t h e i r  in a  randomly  the o u t p a t i e n t  m e d i c a t i o n s by t h e  home  sample  who were g i v e n a d d i t i o n a l  teaching  nurse  in  the  clinic.  The d a t a were c o l l e c t e d to f o u r t e e n  clinic  divided  s e l f - m e d i c a t i o n and t o t a l  of a m b u l a t o r y  function  visit  all  lived at  They were f r o m a  who r e c e i v e d o n l y t h e  their  forty-five  an o u t p a t i e n t  c o m p r i s e d f o r t y male and f e m a l e p a t i e n t s into a control  practices  d i g o x i n , and  a diuretic.  and r e c e i v e d m e d i c a l a t t e n t i o n  of  self-medication  the  days a f t e r  the  visit  55  in the to  the  patients'  homes  outpatient  ten  clinic,  56  by means o f a t w e n t y - i t e m q u e s t i o n n a i r e information  related  The c r i t e r i o n on t h e  errors  in  period  by p a t i e n t s  significantly experimental errors  of  knowledge of  the  that there  was a  in the  number o f  d i g o x i n and d i u r e t i c s  control  fewer  difference  errors.  Although the  there  in e r r o r s  errors  time,  of  experimental  group.  g r o u p made patients  the f o u r  of  knowledge of  as compared w i t h t h e had a h i g h e r II.  type  significant  period  level  of  of e r r o r — t h a t  difference  patients control  in  the  types  of  significant  by  g r o u p a s compared w i t h t h e  in the f o u r t h  A statistically level  twenty-four-hour  There was, however, a s t a t i s t i c a l l y  difference  statistically  dosage and n o n - p r e s c r i b e d  m e d i c a t i o n s made i n a t w e n t y - f o u r - h o u r i n the  of  patients.  was n o t a s t a t i s t i c a l l y of  types  g r o u p , a s compared  The e x p e r i m e n t a l  g r o u p made f e w e r  studied,  study.  self-medication  made i n a  i n the e x p e r i m e n t a l  group.  the  i n s e l f - m e d i c a t i o n , the  indicated  difference  hypotheses of  reveal  s e l f - m e d i c a t i o n b e h a v i o r was b a s e d  level  The r e s u l t s  w i t h the  three  deviations  and t h e  significant  the  measure o f  number o f  deviations,  to  designed to  patients  control  significant of  omission.  was shown i n  in the e x p e r i m e n t a l  group.  knowledge about  the group  The e x p e r i m e n t a l their  group  medications.  IMPLICATIONS FOR NURSING PRACTICE  The r i s i n g i n c i d e n c e o f c h r o n i c and l o n g - t e r m d i s e a s e s r e q u i r e s t h a t p a t i e n t s have an u n d e r s t a n d i n g o f t h e i r c o n d i t i o n s and t r e a t m e n t s . U n d e r s t a n d i n g by  57  p a t i e n t s can lead to i n c r e a s e d c o o p e r a t i o n w i t h t h e r a p e u t i c regimen . . . 7 4 The r e s u l t s  of  c o o p e r a t i o n w i t h the patients  of  a vital  role  their  involvement  practice in p a t i e n t  instructions  some d i r e c t i o n  for  The t e a c h i n g o f  nursing  instructed  teaching  in their  that patients  nursing  In d i s c u s s i n g t h e  limitations  of  study,  the  s o c i o - e c o n o m i c a I Iy. restricted of  to  it  may  regimens provide  clinics.  community study.  are not  presently  i n s e l f - c a r e and m e d i c a t i o n r e g i m e n s .  on t h e s e a r e a s o f  in t h i s  in outpatient  own homes by  i s however s u g g e s t e d t h a t a g r e a t e r  reported  greater  The s t u d y may  some i m p e t u s f r o m t h e  implied  living  Hospitalized patients  d i s c h a r g e home.  patients  i s not  patients  on s e l f - c a r e and m e d i c a t i o n  patient  play  should consider a  teaching.  n u r s e s may d e r i v e It  being  of  the  Because m e d i c a t i o n s  treatment of ambulatory  as a p r e p a r a t i o n f o r  health  r e v e a l e d an i n c r e a s e d  s e l f - m e d i c a t i o n r e g i m e n by t h o s e  medications.  in the  home, t h e  be g i v e n  study  who had been g i v e n p l a n n e d t e a c h i n g a b o u t  effects  at  this  the  It  e m p h a s i s m i g h t be p l a c e d  practice. implications is  The s t u d y  low s o c i o - e c o n o m i c s t a t u s .  the  findings  i m p o r t a n t to emphasize the  study group,  r e s i d e n t s of a  of  b o t h g e o g r a p h i c a l l y and group,  large All  in this  urban a r e a ,  case,  was  and t h e y  were o v e r t h e  age  of  ' Mary L o c k P a l m , " R e c o g n i z i n g O p p o r t u n i t i e s f o r I n f o r m a l P a t i e n t T e a c h i n g , " The Nurs i ng C l i n i c s o f N o r t h Ameri c a . V o l . V I , No. 4 (December, 1 9 7 1 ) , p. 6 6 9 .  were  forty-five  y e a r s and had a d i a g n o s i s o f  C o n s e q u e n t l y the Nevertheless,  s t u d y has  the  findings  limited are of  n u r s i n g , and c o u l d s e r v e to  of  the  role  of  the  significance reported  in  of this  sensitivity  patient  study,  was t h e  interested  greater  health  involvement  increased  ". strict  research, Yet s t r i c t  .  in patient  . One o f  Most  patients  m e d i c a t i o n r e g i m e n , and of  the  interest  t e a c h i n g can  expressed  lead  to  nurses.  the h a l l m a r k s of  over v a r i a b l e s . " - ^ 7  human s u b j e c t  controls  As A r g y r i s p o i n t s spots."  personal  RECOMMENDATIONS FOR FURTHER STUDY  control the  behavior  The e x p e r i e n c e s u g g e s t s t h a t a  job s a t i s f a c t i o n f o r III.  the  problems.  statistical  researcher.  t h e y a l s o seemed most a p p r e c i a t i v e in t h e i r  the  teacher.  rewarding  in d i s c u s s i n g t h e i r  to  and c o n s c i o u s n e s s  self-medication  e x p e r i e n c e e n c o u n t e r e d by t h e were  i n members o f  l e s s i m p o r t a n t than the  the  potential.  considerable interest  n u r s e as a p a t i e n t  P e r h a p s no  conditions.  generalization  stimulate  nursing profession a greater  cardiac  i  n  the  "real  research  behavioral  can c o n t a m i n a t e  can a l t e r  out,  rigorous  the  life"  is  science  results.  situation.  " R i g o r o u s r e s e a r c h has i t s  own  blind  7 6  '-^Chris A r g y r i s , "Issues in E v a l u a t i n g Laboratory E d u c a t i o n , " i n M a r v i n D. D u n n e t t e , J o h n P . C a m p b e l l , and C h r i s A r g y r i s , "Symposium: L a b o r a t o r y T r a i n i n g , " I n d u s t r i a I Re I a t i o n s . V o l . V I I I , N o . 1 ( O c t o b e r , 1 9 6 8 ) , 1 - 4 5 , p . 3 3 7 6  Ibid.,  p.  36.  59 . . . we have t o d i s c r i m i n a t e between t h e w e i g h t t o be g i v e n t o s c i e n t i f i c o p i n i o n i n t h e s e l e c t i o n o f i t s m e t h o d s , and i t s t r u s t w o r t h i n e s s i n f o r m u l a t i n g judgments of the understanding.77 Analysis patient  of  the  data  in this  k n o w l e d g e was i n v e r s e l y r e l a t e d  errors.  T h i s would  indicate  d e c r e a s e d as p a t i e n t  have been o t h e r says,  W a r m t h , or  7  patient  knowledge  involved.  lack of  attitude  toward,  behavior  is conditioned  situation  b a s e d on h i s  given  the  his  illness  linguist,  is  and a t t i t u d e  Hayakawa,  toward  are  the  The c o n t e n t  of  The amount  understanding of,  important.  needs and g o a l s .  His  and  health  p e r c e p t i o n of In t h i s  of  the  study each  was a l s o g i v e n a c a l e n d a r and a  to guide h i s  self-medication  r e s e a r c h e r does n o t f e e l  concluding that patient  may  i n the w o r d s , they  by h i s s u b j e c t i v e  instruction  in order  Therefore  patient  i n c r e a s e d , there  The  patient's  teaching  self-medication  t e a c h i n g must a l s o be c o n s i d e r e d .  c o n s i d e r a t i o n g i v e n to the  pencil  it,  that  self-medication  are p o s s i b l e extraneous v a r i a b l e s .  patient  patient  to  Although  "The m e a n i n g s o f words a r e n o t  in J J S . " ^  the  factors  revealed  that planned p a t i e n t  decreases s e l f - m e d i c a t i o n e r r o r s . errors  study  behavior.  justified  in  teaching alone reduces e r r o r s  in  seIf-medication.  7 7 h r i s A r g y r i s , " A R e j o i n d e r t o D u n n e t t e and C a m p b e l l , " i n M a r v i n D. D u n n e t t e , J o h n P . C a m p b e l l , and C h r i s A r g y r i s , "Symposium: L a b o r a t o r y T r a i n i n g , " I n d u s t r i a I R e l a t i o n s . V o l . V I I I , N o . 1 ( O c t o b e r , 1968), 1-45, p . 45. C  I. H a y a k a w a , Language i n T h o u g h t a nd A c t i on (New Y o r k : H a r c o u r t , B r a c e & W o r l d , I n c . , 1949), p . 292.  60 The f o l l o w i n g  r e c o m m e n d a t i o n s a r e made f o r  further  i nvesti gati on: R e p l i c a t i o n of  1. for  the  findings  be g a i n e d i f of  patients 2.  about the  a consistent were  this  study  effects  of  difference  in order patient  S t u d i e s of  patient  of  self-medication  study are worth t e s t i n g S t u d i e s of  The t h r e e  in broader the  effect  s e l f - m e d i c a t i o n b e h a v i o r of  teaching. explain  hypotheses of  this  studies. of  groups of  patient  t e a c h i n g on  patients  other  than  teaching  on  the  patients. 4.  patient  groups  compliance  c o m m u n i c a t i o n may h e l p t o  c o m p l i a n c e and n o n c o m p l i a n c e .  cardiac  two  might  obtained.  and p a t t e r n s  3.  support  teaching  between t h e  which c o n s i d e r v a r i o u s approaches to p a t i e n t Attitudes  that  S t u d i e s of  self-care  the e f f e c t  behavior  of  patient  in areas other  than t h a t  of  self-med i cat i on. 5.  A study  a s compared t o 6.  of  the  individual  A study of  a s compared t o f o r m a l  the  effectiveness patient  of  group  teaching  teaching.  effectiveness  planned p a t i e n t  of  informal  teaching.  teaching  BIBLIOGRAPHY  61  BIBLIOGRAPHY A.  BOOKS  A b d e l l a h , F a y e G . , and Eugene L e v i n e . B e t t e r P a t i e n t Care T h r o u g h N u r s i ng R e s e a r c h . New Y o r k : The Macmi I Ian Company, 1 9 6 5 . B e n n i s , Warren G. et a l . The R o I e o f t h e N u r s e i n t h e Outpat i ent Department. New Y o r k : A m e r i c a n N u r s e s ' Foundation, I n c . , 1961. Brown, E s t h e r L u c i l e . Change. Toronto:  N u r s i ng R e c o n s i d e r e d , A S t u d y o f J . B . L i p p i n c o t t Company, 1 9 7 0 .  C u t t i n g , Windsor C. Handbook o f P h a r m a c o I o q y . 3d e d . New Y o r k : M e r e d i t h P u b l i s h i n g Company, 1 9 6 7 . H a y a k a w a , S . I. La ngua qe i n T h o u g h t and A c t i o n . H a r c o u r t , B r a c e & W o r l d , I n c . , 19*597  New Y o r k :  H u g h e s , Norman F . , and G e r a l d N. R o t e n b e r g ( e d s . ) . Compendi urn o f P h a r m a c e u t i c a I s and S p e c i a 11 i e s . 6th ed. T o r o n t o : The C a n a d i a n P h a r m a c e u t i c a l A s s o c i a t i o n I n c . , 1971 . F i s h e r , R. A . The Des i g n o f E x p e r i m e n t s . O l i v e r and B o y d , i 9 6 0 . F u c h s , W a l t e r R. Cybernet i cs f o r The Macmi I Ian Company, 1971 .  the  7th  ed.  Modern M i n d .  London: New Y o r k :  S c h w a r t z , D o r i s , B a r b a r a H e n l e y , and L e o n a r d Z e i t z . The E I d e r I y A m b u l a t o r y P a t i e n t : N u r s i n g and P s y c h o I o q i caI Needs. New Y o r k : The Macmi I Ian Company, 1 9 6 4 . S n e d e c o r , G e o r g e W. S t a t i s t i caI M e t h o d s . 5th The Iowa S t a t e U n i v e r s i t y P r e s s , 1 9 5 6 .  ed.  Iowa:  S u s s m a n , M a r v i n B. e t a I. The W a I k i ng P a t i e n t : A S t u d y Outpatient Care. C l e v e l a n d : The P r e s s o f W e s t e r n Reserve U n i v e r s i t y , 1967. Windemuth, A u d r e y . The N u r s e i n t h e O u t p a t i e n t New Y o r k : The Macmi I Ian Company, 1 9 5 7 . 62  in  Department.  63 B.  PUBLICATIONS OF THE GOVERNMENT  Dominion Bureau of S t a t i s t i c s . Queen's P r i n t e r of Canada, C.  Canada Y e a r B o o k . 1970-71.  Ottawa:  PERIODICALS  B e r g m a n , Abraham B . , and R i c h a r d J . W e r n e r . " F a i l u r e of Chi I d r e n t o R e c e i ve P e n i c i I Ii n by M o u t h , " New E n g l a n d J o u r n a I o f Medi c i n e . V o l . C C L X V I I I , No. 2 5 ~ T J u n e 13, 1 9 6 3 ) , 1334-1338. B e r k o w i t z , Norman H. e t a I. " P a t i e n t FoI I o w - T h r o u g h i n Outpatient Department," Nursing Research, V o l . XII, N o . 1 ( W i n t e r , 1963), 1 6 - 2 2 . Berry, David, Patients Irregular Diseases,  the  A l a n R o s s , and K u r t D e u s c h l e . "Tuberculous T r e a t e d a t Home. C o m p a r i s o n o f R e g u l a r and S e I f - M e d i c a t i o n G r o u p s , " Review of R e s p i r a t o r y V o l . L X X X V I I I , No. 6 (December, 1 9 6 3 ) , 7 6 9 - 7 7 2 .  B o n n a r , J o h n , A . G o l d b e r g , and J . S m i t h . Take T h e i r I r o n ? " The L a n c e t ( M a r c h ,  "Do P r e g n a n t Women 1969), 457-458.  C a p l a n , E l e a n o r , and M a r v i n B. S u s s m a n . "Rank O r d e r o f I m p o r t a n t V a r i a b l e s f o r P a t i e n t and S t a f f S a t i s f a c t i on w i t h O u t p a t i e n t S e r v i c e , " J o u r n a l o f H e a l t h and Human B e h a v i o r . V o l . V I I , N o . 2 (Summer, 1966), 133-137. C u r t i s , E l i z a b e t h B. " M e d i c a t i o n E r r o r s Made by P a t i e n t s , " N u r s i n g O u t l o o k . V o l . I X , N o . 5 (May, 1 9 6 1 ) , 2 9 0 - 2 9 1 . Davis, Milton S. " V a r i a t i o n s in P a t i e n t s ' Compliance with D o c t o r s ' A d v i c e : An E m p i r i c a l A n a l y s i s o f P a t t e r n s o f C o m m u n i c a t i o n , " Amer i ca n J o u r n a I of Pub Ii c H e a I t h . V o l . L V I I I , N o . 2 ( F e b r u a r y , 1968T7 274-288. , and R o b e r t L . E i c h h o r n . "Compliance with Medical R e g i m e n s : A P a n e l S t u d y , " J o u r n a I o f H e a I t h and Human B e h a v i o r . V o l . I V , N o . 4 ( W i n t e r , 1963) , 2 4 0 ^ 2 % . D u n n e t t e , M a r v i n D . , J o h n P . C a m p b e l l , and C h r i s "Symposium: L a b o r a t o r y T r a i n i n g , " I n d u s t r i a l V o l . V I I I , No. 1 ( O c t o b e r , 1 9 6 8 ) , 1 - 4 5 .  Argyris. Relations,  F a l c o n e r , Mary. "An E x p e r i m e n t a l Program i n S e l f - M e d i c a t i o n , " C a n a d i a n P h a r m a c e u t i c a l J o u r n a l , (May, 1971), 2 2 - 2 3 . F i s c h e r , M e r c e d e s M. " O u t p a t i e n t D e p a r t m e n t s Have a Long Way To G o , " A m e r i c a n J o u r n a l o f N u r s i n g , V o l . L X I , N o . 8 (August, 1961), 56-59.  64 F i s h e r , Andrew W. " P a t i e n t s ' E v a l u a t i o n of O u t p a t i e n t Med i caI Ca r e , " J o u r n a I o f Me d i caI E d u c a t i o n , V o I . X L V I , No. 3 ( M a r c h , 1 9 7 1 ) , 238-24^ Fox,  David J . "A P r o p o s e d Model f o r I d e n t i f y i n g R e s e a r c h A r e a s i n N u r s i n g , " Nurs i ng R e s e a r c h , V o l . X I I I , No. 1 ( W i n t e r , 1964), 29-36.  Fox, Wallace. "The P r o b l e m o f S e l f - A d m i n i s t r a t i o n o f D r u g s ; With P a r t i c u l a r Reference to Pulmonary T u b e r c u l o s i s , " T u b e r c l e . V o l . XXXIX ( O c t o b e r , 1958), 269-274. GrolIman, Arthur. V o l . L X V , No.  " D i u r e t i c s , " American JournaI ( J a n u a r y , 1965), 84-89.  1  of  Nursi ng,  H a l l b u r g , Jeanne C . " T e a c h i n g P a t i e n t s S e l f - C a r e , " Nurs i ng C l i n i c s o f N o r t h A m e r i c a , V o l . V , N o . 2 ( J u n e , 1970),  223-231.  H a y , S t e l l a , and H e l e n A n d e r s o n . "Are Nurses Meeting P a t i e n t s ' N e e d s ? " Amer i c a n J o u r n a I o f N u r s i n g . V o l . L X I I I , N o . 12 ( D e c e m b e r , 1963), 96-99. H a y e s , E v e l y n R. " C l i n i c W a i t i n g Room E x p e r i e n c e : An E x p l o r a t o r y S t u d y , " N u r s i n g R e s e a r c h . V o l . X V I I , No. 4 ( J u l y - A u g u s t , 1968), 361-364. H e c h t , Amy B. " S e I f - M e d i c a t i o n , I n a c c u r a c y , and What Can Be D o n e , " N u r s i n g O u t l o o k . V o l . X V I I I , N o . 4 ( A p r i l , 1970),  30-31.  J a n k o w s k i , Norman W. With I t , " P a t i ent  89-98.  Kos,  " D i g i t a l i s : I N e v e r Know Where I S t a n d C a r e C I i n i ca I C o n c e p t s ( M a r c h 1 5 , 1 9 7 0 ) ,  B a r b a r a , and P a m e l a C u l b e r t . " T e a c h i n g P a t i e n t s About P a c e m a k e r s , " Amer i can J o u r n a I o f N u r s i n g , V o l . L X X I , N o . 3 ( M a r c h , 1 9 7 1 ) , 523-527.  L e v i n e , Eugene. "Experimental Nursing R e s e a r c h . V o l . IX,  Design in Nursing R e s e a r c h , " N o . 4 ( F a l l , 1960), 203-212.  Mack, M a r j o r i e J . "The P e r s o n a l A d j u s t m e n t o f C h r o n i c a l l y I I I O l d P e o p l e Under Home Ca r e , " N u r s i ng R e s e a r c h , V o l . I, N o . 1 ( J u n e , 1952), 9-30. Ma l o n e , M a r y , Norman H. B e r k o w i t z , and M a l c o l m W. K l e i n . "The P a r a d o x i n N u r s i n g , " Ameri can J o u r n a I o f N u r s i n g , V o l . L X I , No. 9 ( S e p t e m b e r , 1961), 52-55. M a r s t o n , Mary V . "Compliance With Medical Regimens: A Review of the L i t e r a t u r e , " N u r s i n g R e s e a r c h , V o l . X I X , No. 4 ( J u l y - A u g u s t , 1970), 312-322.  65 Monteiro, Lois A. " N o t e s on P a t i e n t T e a c h i n g — A N e g l e c t e d A r e a , " N u r s i n g F o r u m , V o l . I l l , No. 1 ( 1 9 6 4 ) , 2 6 - 3 3 . N e e l y , E l i z a b e t h , and M a x i n e P a t r i c k . " P r o b l e m s o f Aged P e r s o n s T a k i n g M e d i c a t i o n s a t Home," N u r s i n g R e s e a r c h , V o l . X V I I , No. 1 ( J a n u a r y - F e b r u a r y , 1 9 6 8 ) , 5 2 - 5 5 . P a l m , Mary L o c k . "Recognizing O p p o r t u n i t i e s for Informal P a t i e n t T e a c h i n g , " The N u r s i ng C I i ni c s o f N o r t h Ame r i c a , V o l . V I , N o . 4 ( D e c e m b e r , 1971 ) , 6 6 9 - 6 7 8 . P o h l , Margaret L. Practitioner," 1965), 4 - 1 1 .  " T e a c h i n g A c t i v i t i e s o f the Nursing Research, V o l . XVI,  Nursing (Winter,  P u t t , A r l e n e M. "One E x p e r i m e n t i n N u r s i n g A d u l t s w i t h P e p t i c U l c e r s , " N u r s i n g R e s e a r c h , V o l . X I X , No. 6 (November-December, 1970), 4 8 4 - 4 9 4 . Schwartz, Doris. " M e d i c a t i o n E r r o r s Made by Aged P a t i e n t s , " A m e r i c a n J o u r n a l o f N u r s i n g . V o l . L X I I , No. 8 ( A u g u s t , 1962), 51-53. S h u p e , D o n a l d R. "On t h e Use o f C h i - S q u a r e i n N u r s i n g R e s e a r c h , " N u r s i n g R e s e a r c h , V o l . X V I , N o . 3 (Summer, 1967), 279-282. Smith, Dorothy A. " M y t h and Method i n N u r s i n g P r a c t i c e , " Amer i c a n J o u r n a I o f N u r s i n g . V o l . L X V I , N o . 1 ( F e b r u a r y , 1964), 6 8 - 7 2 . Streeter, Virgina. "The N u r s e ' s R e s p o n s i b i l i t y f o r T e a c h i n g P a t i e n t s , " A m e r i c a n J o u r n a I o f N u r s i n g , V o I . LI 1 1 , N o . 7 ( J u l y , 1953), 8 1 8 - 8 2 0 . W a t k i n s , J u l i a e t a I. "A S t u d y o f D i a b e t i c P a t i e n t s a t H o m e , " Amer i c a n J o u r n a I o f Pub Ii c H e a I t h . V o l . L V I I , No. 3 ( M a r c h , 1 9 6 7 ) , 452^4"57. Wood, V i v i a n . " U n d e r s t a n d i n g P s y c h o m e t r i c T e s t s , " The C a n a d i a n N u r s e . V o l . L X I , No. 4 ( A p r i l , 1 9 6 5 ) , 2 8 1 - 2 8 2 . D.  ARTICLES IN COLLECTIONS  D i p a l m a , J o s e p h R. ( e d . ) . D r i I I ' s P h a r m a c o I o g y i n Medi c i n e . 4th e d . New Y o r k : M c G r a w - H i l l Book Company, 1 9 7 1 .  66 E.  UNPUBLISHED MATERIALS  B r k i c h , R i t a M. "A S t u d y t o D e t e r m i n e how P a t i e n t s Their Digoxin Therapy." Unpublished Master's d i s s e r t a t i o n , M c G i l l U n i v e r s i t y , 1969.  View  H a l l b u r g , Jeanne C . "A D e c i s i o n M a k i n g A p p r o a c h a s a Teaching-Learning Strategy for Preparing Patients Self-Care." Unpublished Doctor's d i s s e r t a t i o n , U n i v e r s i t y of C a l i f o r n i a , 1969.  for  Nordwich, Irene E. " C o n c e r n s of C a r d i a c P a t i e n t s R e g a r d i n g T h e i r A b i l i t y t o Implement t h e P r e s c r i b e d Drug T h e r a p y . " U n p u b l i s h e d M a s t e r ' s d i s s e r t a t i o n , U n i v e r s i t y of Western O n t a r i o , 1970. I l l i n o i s I n s t i t u t e of Technology, C h i c a g o . A l e c t u r e given by D r . S t a n l e y B l o c k a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , March 9 , 1 9 7 1 .  APPENDIX A INTRODUCTION TO THE PATIENT  67  68  INTRODUCTION TO THE PATIENT My name i s G e r t r u d e Goodman.  I am a  registered  nurse. Information the o u t p a t i e n t home.  it  person w i l l  to  is a l l  visit  see how t h e y a r e g e t t i n g to  right  you a t  provide  visit  Will  you he Ip?  how you a r e  at  you.  another  y o u r home i n two weeks or  we hope t o  c a r e you r e c e i v e .  I or  visit  along  improved care f o r  with you, either  a s k you q u e s t i o n s a b o u t  From t h i s health  clinic  T h i s i s an e f f o r t If  We w i l l  i s b e i n g c o l l e c t e d f r o m p e o p l e who  getting  l e a r n how we can i m p r o v e  less. along. the  APPENDIX B BIOGRAPHICAL  69  DATA FORM  70 BIOGRAPHICAL  DATA  FORM E, C,  Name (near)  Address Te Iephone_  Sex.  M  Marital Living  F_  Status.  M  S_  Arrangements.  W  ch i I d r e n  spouse_  alone_  D/S_ other aduIts  Age Birth  Date  Re I i g i o n Education.  High  Elementary_  C o I I ege_  school.  Ra c e or  Emp I oyment_  Date  of  Planned  O.P.D. dates  Preferred  List  1 .  2.  3. 4. 5. 6.  7. 8.  of  time  Retired  visit for of  home day  medications  visit for  visit_  Amount  prescribed  Time  prescribed  APPENDIX C SEMI-STRUCTURED INTERVIEW GUIDE FOLLOWED IN PATIENT TEACHING  71  72 S E M I - S T R U C T U R E D I N T E R V I E W GUIDE IN P A T I E N T T E A C H I N G  FOLLOWED  Introducti on: Do y o u f e e l  helped  What  think  Do  do  you  your  it  important  Type  of  Medication  you this  Do  you  Do  find time often  you  the  they  are  an  to  take  them  the  outpatient  c I i ni c?  most?  important  part  of  your  regularly?  Error:  you t a k e vary? forget  you t a k e your the d o c t o r and  visiting  help?  that  Is  Do  helps  medicines  You f e e l t h e n treatment?  after  them  to  at  take  a  specified  time,  or  does  them?  m e d i c i n e s in the e x a c t amounts a s p r i n t e d on t h e c o n t a i n e r s ?  Are t h e r e m e d i c i n e s which you take which w h i c h w e r e n o t o r d e r e d by t h e d o c t o r ?  help  ordered  you,  by  and  Di s c u s s i o n : Sometimes people f e e l they would l i k e about t h e i r c o n d i t i o n . Do y o u ? Do  you f e e l health as  to  be  told  more  y o u w o u l d l i k e t o d i s c u s s i n more d e t a i l well as your m e d i c i n e s with a nurse?  What i n p a r t i c u l a r i n t e r e s t s you i n t h i s p a t i e n t ' s c o n d i t i o n with him/her.)  regard?  your  (Discuss  Know l e d g e : Do y o u wi t h  know t h e names patient.)  of  your  Do  know  of  day  you  what  time  medicines?  to  take  (Go  over  them  them?  A r e y o u i n t e r e s t e d i n how e a c h o n e a c t s on y o u r b o d y , i.e. what i t d o e s f o r you? (Review a c t i o n s with p a t i e n t . )  73 Do you t h i n k some o f t h e s e m e d i c i n e s may have s i d e i f not taken as d i r e c t e d ? What a r e some o f pati ent.)  these?  (Discuss side effects  effects  with  P a t i e n t F e e d b a c k and D e c i s i o n - M a k i n g by P a t i e n t Under G u i d a n c e o f N u r s e : ( I n c o r p o r a t e a l l above conversat ion) Identify  the  goals;  e.g.  Consider  the  relevant  I d e n t i f y and e v a l u a t e  Select alternative;  To t a k e  data;  e.g.  m e d i c i n e s as  Does he f o r g e t ? Eyesi ght. Importance of t a k i n g med i ca t i o n s .  alternatives;  e.g.  This  prescribed.  e . g . Set a l a r m . Use c a I e n d a r . Keep m e d i c a t i o n s on t a b l e .  i s done by  patient.  APPENDIX D A TEACHING DISCUSSION WITH A PATIENT  74  75 A TEACHING DISCUSSION WITH A PATIENT KEY:  P = patient  R:  Do you f e e l  P:  Yes, I think  R:  In what way a r e you h e l p e d ?  P:  I don't  R:  You f e e l t h e n , important part  P:  Yes, I  R;  Is  P:  I  R:  Why do you t h i n k  P:  I don't  R:  T a k i n g y o u r m e d i c i n e r e g u l a r l y w o u l d mean t h a t y o u r body has a c e r t a i n amount o f the m e d i c i n e i n i t a t a l l t i m e s . Then i t h e l p s y o u . This is d e s i r a b l e .  P:  Y e s , I suppose i t  R:  Do you f i n d t h a t you t a k e y o u r m e d i c i n e s a t t i m e e v e r y d a y , o r does t h e t i m e v a r y ?  P:  It  R:  Why?  P:  I don't  R:  Yes, t h a t ' s them?  P:  No. I would s a y n o . since l a s t September.  R:  What a b o u t t h e amount you t a k e . Do you t a k e t h e e x a c t amounts o r d e r e d by t h e d o c t o r , and w h i c h a r e p r i n t e d on your c o n t a i n e r s ?  P:  Yes.  it  helped a f t e r  R = researcher visiting  the  outpatient  clinic?  so.  know.  Well,  the p i l l s  h e l p me.  t h a t t h e m e d i c i n e s you t a k e of your t r e a t m e n t ?  a r e an  do. important  to  take  them  regularly?  guess s o . so?  know.  is. t h e same  v a r i e s sometimes.  always get  up a t  the  understandable.  same t i m e  i n the  Do you o f t e n  I've f o r g o t t e n about T h a t ' s not o f t e n .  morning.  forget three  to  take  times  76 R:  Do you r e a d t h e  P:  Yes.  R:  A r e t h e r e m e d i c i n e s w h i c h you t a k e w h i c h h e l p the d o c t o r d i d not o r d e r ?  P:  We I I, good?  R:  Yes, I t h i n k probably they a r e . H o w e v e r , i t w o u l d not be w i s e t o t a k e p i l l s o t h e r t h a n v i t a m i n s , m i n e r a l s or l a x a t i v e s u n l e s s you d i s c u s s e d t h i s w i t h your d o c t o r and he o r d e r e d t h e m .  P:  No.  R:  Sometimes people f e e l they would about t h e i r c o n d i t i o n . Do you?  P:  No. I'm o l d . a b o u t me.  R:  But i f you r e a l l y w o u l d you?  P:  We I I,  R:  Would you  P:  No, n o t  R:  No?  P:  No, the  R:  What a b o u t  P:  No, I n e v e r  R:  I t h i n k they might answer q u e s t i o n s about your m e d i c i n e s i f you had any q u e s t i o n s . I t may be good t o know f o r y o u r s e l f , s i n c e t h e d o c t o r c a n n o t a l w a y s be w i t h y o u . Is t h e r e a n y t h i n g you w o u l d l i k e t o a s k me a b o u t them?  P:  No.  I don't  I guess  l a b e l s on t h e  know.  I'm  containers?  I t a k e wheat germ p i l l s .  eighty  like  years o l d .  believed that  you, Are  which they  to  be t o l d  more  It  doesn't  matter  you w o u l d n ' t  come h e r e  not.  like  to  know more a b o u t  your h e a r t  condition?  reaI Iy.  doctors the  know what nurses?  they're  doing.  Do you e v e r a s k  them?  have.  (Pause) R:  Do you know t h e  P:  There  is  names o f  "di-oxygen" for  your m e d i c i n e s ? the  h e a r t and t h e n a w a t e r  pill.  77  R:  Y e s , the l i t t l e I t ' s l i k e three — d i gox i n . (Patient  w h i t e p i l l f o r the h e a r t i s d i g o x i n . l i t t l e words p u t t o g e t h e r ; d i g ox i n  repeats t h i s  Do you know what it  several  the water  P:  No, I have  here  in t h i s  R:  Hydrochlorothiazide. ( P a t i e n t n e v e r does m a s t e r hydrochlorothiazide.) What d o e s d i g o x i n  P:  It  R:  Yes.  P:  I don't  R:  Well,  it  heart  beat.  do f o r  h e l p s the h e a r t  times with  pill  is  difficulty.)  called?  bottle.  the  pronounciation  of  you?  work.  In what way? know. slows the  heart  b e a t and i t  Those a r e two  important  strengthens things  the  digoxin  does,  P:  Aha.  R:  And t h e  P: R:  I t makes me go t o t h e b a t h r o o m . Y e s , you p a s s more w a t e r . W i t h t h e w a t e r you a l s o l o s e salt. T h i s can t a k e away any s w e l l i n g o f y o u r f i n g e r s or a n k l e s . Have you had t h i s ?  P:  Oh y e s , my a n k l e s used t o be b i g g e r , ( p u l l s up p a n t l e g s ) and now t h e y a r e O . K . The p i l l s r e a l l y h e l p e d me.  R:  Do you t h i n k y o u r m e d i c i n e s c o u l d have bad e f f e c t s you d i d n o t t a k e them a s o r d e r e d ?  P:  I don't  R:  If a p e r s o n took n o t h i n g happen?  P:  Well,  R:  No, I'm s u r e you w o u l d n ' t . d i d , what m i g h t happen?  P:  Ah—go to  hydrochlorothiazide—the  water  pill?  if  t h i nk s o .  maybe.  the  I  t w i c e a s many a s he s h o u l d , n e v e r w o u l d do  bathroom a l l  would  that.  But s u p p o s i n g a n o t h e r the  time?  person  78 R:  Y e s , a n d he m i g h t f e e l s i c k t o h i s s t o m a c h , o r v e r y s l e e p y , or very weak. T a k i n g t o o much d i g o x i n f o r o n e ' s s y s t e m c o u l d a l s o make a p e r s o n f e e l s i c k t o h i s s t o m a c h . I t c o u l d a l s o make w h i t e c o l o r s l o o k y e l l o w i s h or blurred. Has t h i s e v e r happened t o you?  P:  No.  R:  I f i t e v e r d o e s , you w i l l know t h e c a u s e . c o u l d get i n touch w i t h your d o c t o r .  P:  Yes, t h a t ' s  R:  Yes, I believe it i s . I f one u n d e r s t a n d s b o t h the good and bad e f f e c t s o f a m e d i c i n e , one can t e l l when he s h o u l d see h i s d o c t o r .  P:  Yes.  R:  We were s a y i n g e a r l i e r t h a t y o u r m e d i c i n e s p l a y an i m p o r t a n t p a r t i n k e e p i n g you f e e l i n g w e l l . Would you t h i n k t h e n t h a t t h e y s h o u l d be t a k e n a s p r e s c r i b e d — as w r i t t e n on t h e c o n t a i n e r s f o r you?  P:  Ye s .  R:  What t h i n g s can you t h i n k o f t h a t c o u l d keep you f r o m t a k i n g them a t t h e r i g h t t i m e and i n t h e r i g h t amounts?  P:  I do as i t  R:  I have a l a r g e c a l e n d a r , w i t h a p e n c i l , h e r e . I f you f e e l i t w o u l d h e l p you remember, you can w r i t e y o u r m e d i c i n e s i n on e a c h day a n d t i c k o f f when you have taken them.  P:  Thank y o u .  R:  We I 1, keep i t a n y w a y . I give to h e r e . I f you e v e r f e e l i t y o u ' I I have i t .  P:  Thank y o u . You know, I keep my p i l l s I a l w a y s know where t h e y a r e .  R:  Yes. I have e n j o y e d t a l k i n g w i t h y o u . I will t h e n on Monday, i n two w e e k s , a t y o u r home.  P:  Yes.  I'll  good t o  says.  know.  I don't  I don't  be home.  Then you  think  often  I need  forget  them.  it.  one t o e a c h p e r s o n I t a l k m i g h t be o f h e l p , t h e n on t h e  table  and  see you  APPENDIX E THE QUESTIONNAIRE  79  80 QUESTIONNAIRE 1.  What m e d i c i n e s do you t a k e  2.  May I see t h e the  3.  containers  separately table  for  on page  5.  If  6.  A t what t i m e d i d  7.  Do you t a k e  e a c h one?  need t o  (Go o v e r 6, 9,  you t a k e  this  one  " n o " - why d i d you n o t  take  it?  which  it  at  you t a k e  you t a k e these it  8.  Why does t h e  9.  How much do you t a k e  check  think  it  does f o r  11.  C o u l d any of  12.  If  "yes" -  12 and  complete  today?  it  yesterday?  times  everyday,  or  does t h e  time  vary?  each  time?  you t a k e  help  you?  What do  you  you?  you t h i n k  contact  the  Do you t a k e a n y m e d i c i n e s  14.  Sometimes p e o p l e f o r g e t to  " y e s " - why?  take  your  of  side e f f e c t s  which  would  doctor?  13.  ever f o r g e t  medication  t h e s e m e d i c i n e s have a n y s i d e e f f e c t s ?  could  c a u s e you t o  10,  each  time vary?  Does e v e r y m e d i c i n e  If  I  3.  A t what t i m e d i d  15.  medicines?  Questions 3, 4,  4.  10.  of  labeIs.  How o f t e n do you t a k e  at  regularly?  not  to  prescribed  take  their  medicines?  by t h e  medicines.  doctor?  Do you  81 Page 2 16.  Does anyone a s s i s t you i n t a k i n g  17.  A r e you v i s i t e d  18.  What t h i n g s  do you n o t  19.  Do you f e e l  that  the m e d i c i n e s ?  by a p u b l i c h e a l t h  nurse?  l i k e about t a k i n g  your m e d i c i n e s ?  you a r e t o l d a s much as you want  to  know a b o u t e a c h m e d i c i n e ? 20.  If  " n o " - what  kinds of  about your m e d i c i n e s ?  Name: Address: Date V i s i t e d : I n t e r v i ewer:  things  w o u l d you  like  to  know  Page 3 Name o f medicine  1 .  A  2.  R  QUESTIONS Amount Time Prescribed  How often taken  Time Today  6 taken Yest,  9 Amount taken  10 What does i t do?  12 Side effects  A n a l y s i s of R e s u l t s A. Digoxin & Diuretics B. Other 3,4,6. O m i s s i o n A. B.  I n c o r r e c t time A. B. 9. E r r o r i n amount A.  4,6.  3.  D  4.  I  5.  A  B.  13. Not p r e s c r i bed A. B.  Total  C  Number o f A.  Errors:  B.  0 6. T  7.  H E R  8. 9.  10.  Name: Address: Date v i s i t e d : Inte r v i e w e r :  P a t i e n t Knowledge 1. Name o f m e d i c a t i o n A. B.  10. E f f e c t A.  of  medication  B.  12. S i d e A.  effects  B.  3. When m e d i c a t i o n s h o u l d be t a k e n A. B.  Level A. B.  of  Knowledge  APPENDIX F L I S T OF A L L MEDICATIONS PRESCRIBED FOR THE STUDY POPULATION  83  84  L I S T OF A L L MEDICATIONS PRESCRIBED FOR THE STUDY POPULATION* a 1 dactone  h y d r o d i ur i 1  a 1 dome t  hygroton  a 1 1 o p u r i no 1  KC1  amesec  1 asi x  bemi na1  plus  elixir  paramettes  c h 1 o r o p r o p a m i de  peri trate  c o 1 c h i c i ne  phenobarb  Coumadin  propana1o1  d i amox  s 1 ow K  d i coumero1  t e t r a e y e 1i ne  d i gox i n  t h y r o x i ne  d i 1 ant i n  t o 1 butami de  donnatol  qui ni d i ne  e 1 avi 1  va 1 i urn  hydrochlorothiazide  are  * L i s t i n c l u d e s g e n e r i c and t r a d e names. l i s t e d as the p h y s i c i a n p r e s c r i b e d them.  Medications  APPENDIX G S T A T I S T I C A L TREATMENT OF THE DATA  85  86  S T A T I S T I C A L TREATMENT OF THE DATA  1.  The c h i - s q u a r e employed the  test  of  level  of  The c h i - s q u a r e e m p l o y e d the -V  3.  2  of  significant  test  I  of  -  . 5 ]  .05 or for  all  2  better three  significance for  was  fixed  hypotheses.  Hypothesis  II  Hypothesis  III  formula: _  4 (ad-bc) - f ] (a+c) (b+d) (a+b) (c+d) 2  The c h i - s q u a r e t e s t employed the  [ (o-e)  significance  as s t a t i s t i c a l l y 2.  Hypothesis  formula: = £  The  significance for  of  significance for  formula: =  ^ C(o-e) - . 5 ]  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0101666/manifest

Comment

Related Items