2.3. Data collection

The present research was based on the organizational culture improvement model of patient education, which was designed by Eshqeli Farahani et al. (18). Hence, the following steps were taken to test this model: 1) Pre-intervention phase: In this stage, patients in the control group received no intervention other than the routine therapeutic and care programs. The dependent variables (patient’s anxiety and satisfaction) were studied at the beginning of the research and the time of releasing patients. 2) Intervention phase (testing the designed model): Samples were selected using the convenience sampling method. The designed organizational culture improvement model of patient education was applied to the experimental group by the nurses, and the dependent variables (patient’s anxiety and satisfaction) were studied at the beginning of the research and at the time of release. The intervention included the following components:

For this purpose, three training workshops on methods of effective communication were held for nursing administrators (matrons, education supervisors, and clinical supervisors) and nurses. These workshops were on three different days through lectures, discussions, case studies, and topical pamphlets.

Following a briefing session, the researcher (the first author of this paper) discussed the notions, philosophy, objectives, and implementation of the model with nursing administrators and nurses, and used their opinions and suggestions. Afterwards, in collaboration with the aforementioned individuals, he formed a committee on planning, implementation, supervision, and control of the patient education program. Moreover, at the time of implementing this model, official and non-official sessions were held with all members on the provided educational program and their opinions and recommendations were used. In this stage, all of the group members reached consensus on different steps of implementation and method of implementation.

In this phase, the primary and secondary objectives were determined based on patients’ needs and problems and in accordance with educational standards through a step-wise process. Moreover, the form of assessment of patients’ educational needs, which was designed based on educational standards and the committee’s opinion, was provided to the nurses.

The patient education program was implemented in a place with suitable sound level, lighting, and factors for six days in accordance with the major and minor goals of the program. Two educational posters were attached in locations with the highest possibility of use, and a pamphlet, which was developed based on the needs and opinions of the education program’s committee, was presented to the patients. It shall be mentioned that the content of the pamphlet and posters were approved by an internist, a heart surgeon, and a nutritionist. The teaching method, implementation of the education program, and installation of posters were determined based on the opinions and suggestions of members of the education program committee of the project. According to the ward routine and hospital’s policy, patients hospitalized in CCU were introduced to the education program, training sessions, and training contents on the first day. They also received information on the surgery, respiratory exercises, and method of providing care in the ICU open heart surgery ward. Following the surgery, when the patients were transferred from the ICU open heart surgery ward to the general ward, they partly recovered their physical, psychological, and mental well-being and the education program was followed within different days in accordance with the educational content and educational needs of patients. Each day patients were asked questions, which would motivate learning on the next day based on the educational contents of the following day. Examples of these questions included the following: Do you know which diet is suitable and useful for you? Do you know why aspirin was prescribed for you? Do you know the best time for consuming the prescribed aspirin? During the training sessions, the nurses gave examples to clarify the contents and patients’ understanding of the education program. They also used strategies such as contents review, model presentation, and persuasion of patients to facilitate learning and to motivate patients. The presented educational program was reviewed on the fifth and sixth days and all of the questions and problems of patients were addressed. At the end of each phase, the nurse in charge of training recorded the presented programs.

The nursing administrators supervised and controlled implementation of the educational program both directly and indirectly. A checklist was developed for this purpose based on standards for evaluation of the educational program and opinions of the education program’s committee. In addition, results of evaluation were reported to nurses to reinforce the strengths and eliminate weaknesses. Nursing administrators used strategies for valuing and institutionalizing education to encourage and support nurses in this regard.

The nurses received financial and spiritual incentives (such as fees, written encouragement, and oral encouragement) based on their performance. The nurses’ performance regarding education of patients was recorded on their occupational files and was taken into account in their evaluations. In addition to nurses, motivational actions were also taken for patients. Some of these actions included informing patients of their educational rights and their disease and treatment process, creating pamphlets and attractive/appropriate posters, encouraging patients’ peers to educate each other, asking motivating questions, encouraging patients to find the risk factors associated with their coronary artery disease, considering these factors in following comprehensible/simple educational recommendations on preventing restenosis of grafted arties and treating/caring on the basis of disease pathophysiology, evaluating levels of awareness, performance and attitude of patients regarding the received education, and reporting evaluation results to patients.