This research has explored 45 health education competencies for PHC nurses in S.A. by including expert participants in three rounds of Delphi. The recommendations from this research will be divided in different aspects, in the following section.
Recommendations for policy makers
In order to keep up-to-date with wider changes along with health concerns, primary healthcare policies have to be updated regularly and checked frequently in order to ascertain the importance of health education within the PHC setting. This could draw upon the MOH strategies that are regularly updated. However, more specific focus and attention on health education practice are needed. This can be achieved by presentations as to how health education improves health outcomes and decreases complications for diseases when they have occurred.
It would be interesting to assess the work performance of PHC nurses and ensure staff development through providing training courses regarding boosting the performance of health education within the PHC setting. This was a main outcome from the workshop. These courses have to be evaluated and updated frequently in order to accomplish their aims.
Greater efforts are needed to ensure the practice of health education within the PHC setting by frequently assessing and evaluating the practice of health education by PHC nurses as this was an outcome from the workshop. This can be achieved by comparing the health education practice in S.A. with other
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countries such as the UK, where practice nurses play an important role in health education via education classes and consultation clinics. It is further recommended to develop a ‘peer evaluation’ that PHC nurses evaluate the performance of health education for their colleagues.
Considerably more attention and care will required to determine the suitable environmental factors and managerial support which will enhance the process of health education, including building of the PHCCs and educational materials, as discussed by Bergh et al. (2012) that the practice of PHC nurses as health educators is influenced by organizational and managerial support. Recommendations for nurses mangers
It is suggested that providing training courses for the staff will be effective to improve their skills and knowledge of health education, as Mersal and Keshk (2012) found that intervention programmes for nurses in MCH centres enhanced the performance and knowledge for them regarding health education. This can be done through developing courses run by expert nurses and nurse mangers who participated in this study, and the course content will be based upon the research findings. Therefore, health education performance by PHC nurses will enhanced.
It is vital to indicate the barriers to providing health education and try to solve these issues. Douglas et al. (2006) listed some barriers that impede health education processes within the PHC setting such as: lack of extra payment and rewards, lack of time, and insufficient educational materials. The nurse managers have to overcome these struggles by different means: reward the staff (increase payment), provide educational materials, and improve the environment by providing private room for health education sessions.
It is essential to maintain good communication and relationships with the health professionals from a different faculty to promote teamwork. Abdulhadi et al. (2013) mentioned the importance of teamwork when providing health education as this can be an obstacle which has to be resolved. It is important to schedule regular meetings with all health professionals in the PHCCs in order to exchange ideas and share experiences regarding health education. This meeting can take place in the PHCC itself or on-line via skype.
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Rewards and incentives should be provided for PHC nurses who have successfully incorporated health education into their role, through regular assessment and supervision of staff. Rewarding could include the provision of study scholarships, conference attendance, or increased payment.
It has been noted to provide an appropriate environment to conduct health education sessions, as this has an influence upon patient nurse interaction. Recommendations for PHC nurses
The PHC nurses need to consider providing health education to the patients visiting PHC centres, as one of their roles. This is clear in the Saudi strategic plan for PHC nursing, which recommends competence for all nursing activities within the PHC setting including health education. This can be achieved by ensuring health education practice is included in the job descriptions of PHC nurses in S.A.
The PHC nurses have to enrol in courses that improve their skills and enhance competence in health education. These courses concerned with the practice of health education may be within the gulf countries or globally. In future, after this study is published, there will be a post-qualifying course for PHC nurses that are concerned with health education.
The PHC nurses have to be aware about the cultural differences between the patients, as S.A. is a multi-cultural country. This is a critical issue as S. A. is a multicultural country, which has nine million individuals from overseas (World Population Review, 2016). The PHC nurses have to respect all cultures and deal with the patients as humans without discrimination, keeping in mind the individual’s needs.
The PHC nurses have to listen and respond carefully to patients’ needs, to be aware of verbal and nonverbal communication, as Abdulhadi et al. (2007) confirmed the importance of communication during health education through eye contact, attention, and encouraging patients to ask questions.
Recommendations for service users
It is advised to support service user involvement in research activity. Williamson et al. (2007) pointed out the importance of involving service users within the research process starting from proposal of the topics and ending
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with writing reports about the findings. Service user involvement is recommended for future research in order to have a positive influence and achieve the research aims.
It is meaningful to have the contributions of service users with groups of health professionals.
It is suggested to keep the outcomes from the service users in hand when developing health policies as well as curriculum planning in the nursing colleges, in keeping with the experience of (NICE) (2013) when involving service users and the public in NICE guidance.
Further research is needed to fully comprehend the issues raised by this research study. Areas to take forward include:
Health education competencies require development for more specialised health issues, such as smoking, asthma and safety precautions. This would build on the current study, which has sought to identify core health education competencies, prior to development of more specialised knowledge and skills.
The effects of the main barriers in the process of health education, such as lack of time, inappropriate environment, and lack of encouragement and motivation.
The influence of communication skills on health education, such as poor eye contact and an unfriendly welcome.
The role of PHC nurses in supporting and providing health education for people with chronic diseases, such as diabetes and hypertension.
The attitudes, beliefs and behaviours of PHC nurses towards health education.
Views and attitudes of PHC nurses regarding increasing their knowledge of health education for alcohol or other drug use, and dealing with patients who complain of mental health disorders.
Exploration of PHC nurses’ knowledge about different methods of education styles, including use of drama and using outside resources.
The strategic development of continuing education courses for PHC nurses concerning health education and evaluation of the impact of these courses.
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