How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

OBJECTIVE: To understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted. DESIGN: Ethnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes. SETTING: A Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic. PARTICIPANTS: 10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study. RESULTS: We observed that the nurses attempted to implement the programme’s core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients’ life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme’s principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand. CONCLUSION: Individual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient’s life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients’ knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme’s core principles in the implementation context.