Original Research

IJNHS
Filipino Nurses’ Experiences in
Conducting Health Education in the
Emergency Room
Al-Sharif A. Sali1, Rica Rose May A. Rubio2

Western Mindanao State University, College of Nursing, Zamboanga City,

Philippines1,2

Article info Abstract

Article history: Background: Nurses face more challenges in delivering health

Received: April 22th, 2022 education in contexts where the milieus are not well defined,
Revised: May 08th, 2022 such as the emergency room (ER). Objective: This study aimed
Accepted: May 25th, 2022 to explore the experiences of ER nurses in conducting health
education inside the ER and identify the most common barriers
Correspondence author: therein. Method: A phenomenology approach was utilized
Dr. Rica Rose May A. Rubio involving Ten ER nurses purposely chosen for the interview.
Address: Western Mindanao Braun and Clarke's framework was used in data analysis.
State University College of Results: The participants' experiences were expressed and
Nursing, Normal Road, represented in the following themes and subthemes: The theme:
Baliwasan, 7000 Zamboanga Experiences in Conducting Health Education in the ER consists
City, Philippines of three subthemes: (1) Routine Work in the ER, (2) Length,
E-mail: [email protected] Frequency, and Manner in Conducting Health Education, and (3)
Feelings Derived from Conducting Health Education. The
theme: Barriers to Health Education in the Emergency Room
International Journal of comprised the six subthemes: (1) Lack of Time, (2) Language
Nursing and Health Services Barrier, (3) Patient’s Psychosocial State, (4) Patient’s Cultural
(IJNHS) Beliefs, (5) Nurse’s Lack of Knowledge, and (6) Lack of
Volume 5, Issue 3, June 20, 2022 Infographic Materials. Recommendation: Based on the findings,
DOI: 10.35654/ijnhs.v5i3.597 the conduct of health education in the ER can be done. Knowing
E-ISSN: 2654-6310 the barriers can assist ER nurses and the hospital administration
in producing the best solutions to solve them, thereby improving
the quality of nursing care in the emergency room.

Keywords: emergency room nurses, health education,

infographics, phenomenology, Philippines, thematic analysis.

This is an Open Access article distributed under the terms of the

Creative Commons Attribution 4.0 International License CC BY
-4.0

International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 267
INTRODUCTION included studies with interventions that
According to the World Health continued after discharge from the emergency
Organization (1), health education is an department, those conducted in the coronary
important strategy for health promotion that is care unit, and those in acute care wards. The
essential for improving people's health and study's authors concluded that educational
encouraging health investments. However, this interventions in these settings, including the
has not received the necessary attention. The emergency department, have improved patient
lack of interest stems from various causes, outcomes. While there are some parallels
including a lack of awareness among health between the emergency room and other acute
professionals and the difficulties that health care settings, several vital differences may
educators face in translating efficiency into impact essential factors related to educational
good results for their practice. There were effectiveness, such as the time needed for
numerous examples of health education success teaching and the patients' anxiety. Ongoing
stories in schools (2), workplaces (3), and counseling and education are ideal, but getting
communities (4,5). However, delivering health patients to attend education sessions can be
education in contexts where the milieus are not difficult.
well defined, such as the emergency room, Effective health education in the ER
becomes more challenging (1). poses many challenges for nurses. Thus factors
With an increasing number of disease that pose barriers should be investigated.
spectra and other health problems, as well as Because there is not enough literature to
the constraints of crowding and unpredictable provide a clear image of the health education
workload, conducting health education in the process in the emergency room locally and
ER is seen as the right place (6) to improve internationally, knowing these aspects can
patient satisfaction and compliance with assist ER nurses and hospital administration
doctor's recommendations, preventing come up with the best answers on how to solve
complications and early readmission (7). A lack them.
of health education can lead to a high number
of repeat hospital visits, both expensive and OBJECTIVE
unsafe to the patients' health and convenience The study sought to examine emergency
(8). As a result, delivering health education is an room nurses' experiences in conducting health
essential element of preventing these problems education and identify the factors that serve as
while effectively providing the high level of barriers therein.
care nurses provide.
Health education is a common role METHODS
within the practice of nursing. Different authors Design
and experts have defined it in various ways (9, The study utilized a phenomenological
10, 11). But this study refers to any instructional design focusing on the emergency room (ER)
activity done by the emergency room (ER) nurses’ experiences conducting health
nurses aimed at providing the patients education in the ER using a researcher-made
admitted to the ER. their families or significant questionnaire.
others information regarding their health As explained by Teherani et al. (13), the
condition, among others. The procedures, approach to phenomenology seeks to describe
referrals, prevention of complications, and the essence of a phenomenon by exploring it
discharge instructions. from the perspective of those who have
Little is known regarding the success of experienced it. This research design applies to a
providing health education in the emergency study focused on a group of people, in this case,
room. A review by Wei and Camargo (12) the emergency room nurses, whom the
synthesized the research on patient education researchers need to understand more
in the emergency department (ED) and comprehensively and profoundly (14).
identified studies related to patients with
asthma, MI, mental conditions, trauma, and Sample size and sampling technique
injury. Because studies focused on education The study participants were the nurses
done exclusively in the ED are limited. They assigned to the ER (Table 1). Purposive
International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 268
sampling was utilized. Ten ER nurses were After the hospital granted permission to
selected following the inclusion criteria of at conduct the study, informed consent was
least two years of working experience in the ER distributed to all participants with complete
department and were willing to participate. information regarding the research study,
design, and purpose. The interview schedule
Table 1. Summary Profile of the Participants was planned relevant to the convenience and
Participant Age Gender Years of availability of the participants to avoid
No. Working disruption from the flow of their job and
Experience in personal time routine. The researcher then
the ER
conducted the interviews on the 16th and 17th
1 37 Female 10
days of January 2020.
2 55 Female 5
3 27 Male 4
4 25 Female 3 Data analysis
5 33 Female 8 The data collected were analyzed using
6 31 Male 5 Braun and Clarke framework (15) in thematic
7 31 Female 7 analysis (Table 2).
8 26 Female 4
9 23 Female 2 Table 2. Braun & Clarke’s Framework for Thematic
10 23 Female 2 Analysis
Steps Task
There were only two male nurses among 1 Familiarization of Data
the participants. The participants ranged from 2 Development of the Initial Codes
23 to 55, and the average age was 31.1. They had
3 Identification of themes
an average work experience of five years. One
4 Re-examination of Themes
of those ten presented herself as the ward
5 Definition of the Final Themes
supervisor, and the rest were the ER ward staff
nurses. The supervisor also fulfills her ER nurse 6 Creation of the Write-up
duties, especially when the ward is
understaffed. The researchers were able to Familiarization of Data. Braun and
conduct the interviews on two shifts. Clarke (2006) recommend that researchers
thoroughly read the entire data set at least once
The instrument for data collection before beginning coding, as ideas and
A researcher-made questionnaire was identification of possible patterns may be
used to gather data. Two nurse experts with shaped as researchers become familiar with all
more than 15 years of experience in the field aspects of their data. In this study, the
validated the questionnaire. Their comments researchers needed to do several readings of the
and suggestions were incorporated into the data transcript to be familiar with its content
questionnaire, resulting in eight open-ended while making notes about the ideas for coding.
guide questions. The original transcript was in mixed Tagalog
The validation resulted in a questionnaire and English and was translated to English for
with two parts. Part 1 of the questionnaire better understanding and presentation
pertains to the demographic profile of the purposes. The participants' responses were
participants, including age, gender, and several systematically arranged in a tabular form
years in the emergency room. Part 2 of the following the interview guide questions.
questionnaire comprises eight guide questions. Development of the Initial Codes.
Five guide questions intend to elicit the Braun and Clarke (2006) recommend
participants’ experiences in giving health systematically working with the whole data set,
education in the emergency room. At the same providing full attention to each item in the data,
time, three questions intend to produce the identifying exciting aspects in the items, and
factors that the ER nurses perceived as barriers labeling or coding them, as they may become
to conducting health education in the ER. the basis of themes representing the data set.
The researchers identified essential text
Data collection process sections, usually phrases in the text, and labeled
International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 269
or coded them as they relate to a theme or the shorter and longer quotes from participants in
objective in the study. These labels or codes the presentation of the results. All quotations
were arranged and grouped into themes to were accompanied by a label (i.e., P1) to
represent the phenomenon of interest. demonstrate that all participants were
Identification of Themes. A theme represented across the results. The short
must capture something important concerning quotations help illustrate the prevalence of the
or directly relevant to the research objectives or themes, while the more extended quotes
questions and is not dependent on quantifiable provide readers with the taste of the original
measures (Braun & Clarke, 2006). In this study, narratives. To add richness to the data, the
the researcher formed two main themes that writing of the results was augmented,
had direct relevance to the research questions supported, and sometimes contrasted with the
and created subthemes for each central theme. data from literature reviews and related studies
Re-examination of Themes. The used to inform this study.
validity of each formulated theme is examined
to see whether the themes correctly represent Ethical consideration
the meanings in the data set (Braun & Clarke, Before data collection, ethics clearance
2006). In this study, the re-examination of the for implementation was obtained from the
theme was done by members of Technical Panel Western Mindanao State University College of
assigned to review this study. They examined Nursing Ethics Review Committee (2019-002-
the validity of each formulated theme to see CN-GS-SBR). The agency concerned also
whether the themes correctly represent the received a letter granting permission to conduct
meanings that appear in the data set as a whole. the study.
Two technical panel members have found the The purpose of the study was explained
need to rename two subthemes. These are to the participant, and they were made aware
"Limited staff," which was renamed to that they could withdraw from the study
"Limited-time," and "Patient's culture," without penalty. They were assured of their
renamed to "Patient's cultural values. Likewise, rights to confidentiality. Hence, each
upon reviewing the themes and the transcripts, participant was assigned a code to avoid using
the researchers renamed the subtheme their name. The codes were P1 until P10, with
"Experiences in the conduct of health "P" meaning "Participant ."The researcher
education" to "Length, frequency, and the secured the consent from the participants before
manner in conducting health education." the actual data gathering.
Definition of the Final Themes. The
analysis for each identified theme must be RESULTS
detailed, relating to the story it tells, clearly The presentation of the main themes
defining and describing what the themes are all culled out from the analysis of the interviews is
about (Braun & Clarke, 2006). The researchers guided by the research objectives.
described the coverage and content of each
theme and ordered the themes in a way that Central Theme 1: Experiences in Conducting
answered the research objectives. Also, the Health Education in the ER. This theme consists
subthemes were described and organized to of three subthemes as follows:
represent the main themes. The researchers Routine Work in the ER. The
participants' usual everyday routines in the ER
revisited the themes to ensure that the
participants' powerful words were used in the can be seen in the following interview
themes. transcripts:
“When there are patients for admission, I
Creation of the Write-up. In writing the
routinely assess the patient's background,
report, excerpts from the raw data need to be
health, and family history to determine the
placed within the analysis to show the intricate admitting diagnosis of the patient, which is the
story of the data, going beyond its description role of the resident on duty. Other things that I
and convincing the reader of the validity and usually do is to carry out doctor's order” (P1)
value of the analysis (Braun & Clarke, 2006). In “My everyday routine in the ER includes
the write-up of the report, researchers included triaging, assisting the ROD in some procedures,
assessing patients' condition and prioritizing
International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 270
 them, do emergent, urgent, and initial care, then and patient can briefly understand what I am
admit the patient for hospital care” (P2) trying to say” (P8)
“I assist doctors in managing emergencies. “Yes, as much as possible, I give a short but
Process admission, check e-cart, taking vital clear health education which ranges from 5-10
signs, provide health education” (P3) mins” (P9)
“I participate in code blue, patient “Sometimes yes and sometimes no. I do it
assessment, starting IV lines, carrying out whenever or while I perform the nursing
doctors’ orders, first aid, and wound dressing” intervention. Five minutes would be long
(P6) enough” (P10)
“When I arrive in the Emergency Room, I
always check the E-Cart” (P7) Feelings Derived from Conducting Health
“For my every duty in the Emergency Room, Education. The interview transcripts related to
upon entering the unit, I always check the E- this are:
CART. After checking, I listen to the outgoing “Giving health education to my patients
nurse for endorsement. And lastly, I ready myself makes me feel good, especially when it is
for the 8–12-hour shift” (P8) beneficial for them, and they will thank you in
“Code blue, attending to critical care like return” (P1)
stab wounds or gunshot wounds and OB cases “I would find the experience fulfilling and
such as OB delivery” (P9) enjoyable despite the limited time available. The
“The most usual thing I do is whenever the patient and their significant others are very
patient comes in, I take her vital signs and eager and receptive to education. They are
immediately provide the necessary nursing care. showing their utmost gratitude after that" (P2)
I check and conduct a quick assessment on the “My experience in giving health education is
patient based on the chief complaint” (P10) okay for as long as the patient is cooperative”
(P7)
Length, Frequency, and Manner in “Rewarding and fulfilling. I have dreamt of
Conducting Health Education. The interview becoming an ER nurse, and I am having the time
transcripts for this subtheme are: of my life” (P9)
“When needed, a few minutes will do since it “I usually do health education whenever I
is always busy in the ER. I sometimes use true- see that there is a need to do so. But there are
to-life situations as an example” (P1) times when we are only a few inside the
“From time to time. The best time to educate emergency room, I have a hard time doing health
patient is while you are doing your assessment. education” (P10)
Usually, it lasts for 1-3 minutes while I am
assessing the patient” (P2) Main Theme 2: Barriers to Health Education in
“Always. The topic depends on the situations the Emergency Room are those identified by the
and the care, and I won’t stop until they participants that give them difficulty in
understand the instructions” (P3).
conducting health education. It comprises six
“I give health education as many times as I
subthemes as follows:
could depending on the patients’ needs. At least
five minutes will do” (P4)
“Occasionally, it depends on the situation. I Lack of Time. This subtheme was
explained what’s important. If the area is too mentioned as a barrier for nurses in conducting
busy, I do it usually within 5 minutes” (P5) health education in the emergency room by two
“Yes, as much as possible but only for about participants:
5 minutes before transporting patients to their “Time and lack of enough staff” (P5)
respective wards. I stress the most important “…and the lack of time” (P6)
aspects of their treatment” (P6)
“I give health education as often as possible Language Barrier. This subtheme refers
to all the patients while simultaneously doing the to the different dialects of the participants,
nursing procedures. It is not long enough,
which posed as a communication barrier in
however, since we are short of staff” (P7)
giving health education in the emergency room:
“I do health teaching if the patient can’t
understand the explanation of the doctor. I do it “Yes, when there is a barrier like
precise and concise so that the significant others establishing coherent communication
with the patient. Even though I know a
little, I would still shy away from trying
International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 271
 to use their dominant dialects in DISCUSSION
conversing with them. I only use The first main theme, "Experiences in
Tagalog, generally” (P1) Conducting Health Education in the ER," included
“I sometimes encounter difficulty in the participants' responses to questions
giving Health Education because the regarding their work routines, the conduct of
language that I use is not familiar to the health education, and their feelings derived
patients that I am dealing with” (P7) from conducting health education in the
“At some point yes, maybe because of the emergency room (ER).
language barrier. There are terms in The subtheme “Routine work in the ER”
their dialect that are hard to understand” pertains to the activities done by the
(P8) participants in the emergency room. Their
“Yes, when the patient uses other routine activities are similar and are the
dialects which are unfamiliar to me” expected activities in the ER. Only Participant 2
(P10) expressed that her everyday routine in the ER
includes Triaging, among others. She further
Patient’s Psychosocial State. This explained that Triaging demands a lot of
subtheme refers to the involvement of mental nursing skills, nursing judgment, can be time-
and social or behavioral aspects of the patients consuming, and should utilize all five senses.
that can pose as barriers to health education in Nurses in the ER prioritize their patients
the emergency room: according to the TRIAGE assessment, which
“First is the language barrier and means sorting patients into priority groups
second is anxiety. When the patient is according to their needs and available resources
anxious, they tend to have difficulty (16). Triaging is recognized as the primary role
understanding what I say” (P4). of triage nurses, which is distinctive to the
“…. being uncooperative, and the lack of emergency department and linked with
drive and willingness to learn” (P7) desirable outcomes (17).
Aside from triaging, the participants
Patient’s Cultural Beliefs. This routinely assess the “patient's background, health,
subtheme pertained to the rituals or other and family history" (P1) to determine and deliver
traditions of the patients that a participant the initial and timely care to their patients.
expressed as a barrier to health education in the Evaluating the patient is vital to ensure that no
emergency room: medical risks predispose the patient to any
“It’s culture. They have their own emergency during the actual procedure.
beliefs and tradition that they refuse to Subsequently, Participant 2 and Participant 3
open to new techno-social and medical "assist" the resident doctors in some methods.
advancement” (P9) While other participants (P1, P6) "carry out
doctor’s orders” routinely.
Nurse’s Lack of Knowledge. A Participants' responses such as "always
participant mentioned this subtheme as one check the e-cart" (P3, P7, & P8) ensure the ward
factor that can pose difficulty in conducting of the complete emergency equipment, medical
health education in the ER. supplies, expired drugs, or medication is being
“It depends on the occasion and if checked correctly. They do this routine to
whether the nurse is knowledgeable prepare for all types of emergencies or the
enough on a certain health topic” (P3) sudden influx of patients coming in.
ER is an area to be equipped with staff
Lack of Infographic Materials. A providing treatment for all types of life-
participant mentioned this subtheme as another threatening diagnoses which require prompt
factor that can pose difficulty in conducting medical care. It was understandable that two
health education in the ER: participants (P6 & P9) mentioned "code blue" as
“…and lack of infographic materials” part of their routine work. It is the term used by
(P10) most hospitals when there's an urgent medical
emergency and indicates that a patient is

International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 272
requiring resuscitation or in need of immediate health education to patients in the ER.
medical attention. Acknowledgment from the patients or their
The subtheme “Length, Frequency, and significant others is an external motivation that
Manner in Conducting Health Education” includes allows nurses to feel a sense of recognition for
the participants' responses regarding how long, their work. Nurses feel contentment when jobs
how often, and how they conduct health are accomplished according to time and
education in the ER. standards. Each task being accomplished
Most participants gave a straight "Yes" reflects on the nurse's ability to deliver quality
when asked if they provide health education care, as seen during health teaching and
inside the ER. As part of their responsibilities as keeping the patient always informed, despite
health educators inside the ward, most give the heavy workload or even low nurse-to-
health education in a short or sometimes more patient ratio.
extended period or on a case-to-case basis. On the other hand, Participant 10
Participants 1, 2, and 5 emphasized from time to seemed not to agree with the other Participants
time because of some cases that need urgent as she had a “hard time” doing it because it
care like cerebrovascular accidents in which makes the ER less efficient in dealing with other
they somehow could no longer provide health critical matters. This feeling is echoed in the
teaching to the patient but to the significant sentiments of two veteran ER nurses who
others only. participated in a study by Devinney (19). The
It would take them an average of five nurse participant with 20 years of experience in
minutes to do health education by highlighting the ER in Devinney’s study expressed that it is
the most critical information and very time-consuming to do health education in
simultaneously do it while giving care. As a that area because of the many patients and the
solution to the barrier of lack of time for health- fast-paced environment of the ED. At the same
promoting activities, Casey (18) suggests the time, the other participant with 11 years of
concept of "opportunistic health promotion" experience in the ED does not believe that most
(p.1043), or informal teaching during the patients in the ED want education. After
provision of care. Providing health education to attempting to teach, she usually walks away
the patient should focus on the most significant feeling like she has wasted her precious little
''must know'' information. As much as possible, time.
the least amount of data should be done to A study by Cross (21) on the attitudes of
avoid confusing the patient. The most critical emergency nurses toward health promotion in
and vital information should be stated first or their work area found that health education is
last, making the key points clear. All too often, not a welcomed activity in the emergency
the ER nurse can give the patient health department, as evidenced by statements of
education to the best they can that is restricted rejection (that ED is a stressful environment) by
to essential forms, salient information and some participants in the study.
prescriptions, and any other incomplete health The second main theme, “Barriers to
promotion (19). Health Education in the Emergency Room,"
In a study by Kelley and Abraham (20) included the participants’ responses regarding
on nurses' role identity regarding health the factors that interfere with health education
promotion. The participants believe that part in the emergency room.
and parcel of their roles and responsibilities are The subtheme “Lack of time” was
giving health-promoting advice to their reported by two participants (P5 and P6)
patients; however, very few provide health mentioned as a barrier for nurses in conducting
promotion and education regularly. The nurse health education in the emergency room. This is
participants argued that it is more challenging similar to the result of the thesis done by
when it conflicts with other work Devinney (19) regarding patient education in
responsibilities. the emergency room. The participants of the
The subtheme “Feelings Derived from thesis considered the time the most significant
Conducting Health Education” pertains to the barrier to patient education in the said
feelings that nurses experienced in giving department. Another study has shown that

International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 273
92.8% of the Canadian emergency department patients formed an impassable barrier to health
nurses (n=223) perceived the lack of time as the education. They added further setbacks that
primary barrier (moderately or very influential) could dampen nurses' enthusiasm for
to patient health education in the emergency providing health education in the ER.
room (22). Participant 1 expressed this sentiment, "Even
The Emergency Room is an area though I know a little, I would still shy away from
specializing in emergency treatment providing trying to use their dominant dialects in conversing
acute care for individuals. Due to the with them ."Such concerns by Participants 1 and
unplanned nature of patients' cases, nurses 7 are legitimate as several studies show
cannot provide ample time to conduct health language or communication barriers can lead to
teachings to the patient. Most nurses dwell misunderstanding between health
immediately on other priority cases, providing professionals and patients. In return, this
initial treatment for illnesses and injuries, some misunderstanding can lead to unsatisfied
of which may be life-threatening and require working relationships between health
immediate attention. Thus, there is a cease of professionals and patients, patient safety, and
information sharing to patients attended the quality of healthcare delivery (24).
because of the limited time. Moreover, a study showed that thirty
Ideally, ER nurses are experts in percent had difficulty understanding medical
prioritizing nursing care and quick nursing instructions among patients who received
intervention for the patient. However, one of treatment from nurses who did not speak the
the most common problems inside the ER is the local language. Thirty percent had a problem
lack of patient teaching because of the smaller with the reliability of the information, and fifty
number of staff nurses. This has been proven in percent believed that the language barrier
this study whereby all the participants said contributed to errors (25). Another study found
“Yes” when asked if they agree that the lack of that forty-nine percent had difficulty
enough staff hinders nurses from providing comprehending a medical situation among
health education to the patients in the ER. patients who did not speak the local language.
The nurse-patient ratio should be 34.7% had inadequate knowledge of medication
equivalent so that health care provision is use, 41.8% had trouble comprehending the label
implemented along with health education. of medicine, and 15.8% had an adverse reaction
However, in this case, the researchers to drugs due to a problem in comprehending
elaborated on the lack of staff for the ER of the the instructions given by the health providers
said hospital. This lack of staff resulted in a “lack (26). Furthermore, patients who were not
of time” when dealing with a patient for health proficient in the local dialect experienced
teaching. Being able to extend and deliver unwanted health incidents that resulted in
knowledge and keeping patients well informed 49.1% of patients with detectable physical
of their situation, intervention, and harm, 46.8% with moderate temporary damage,
management despite the increasing demand of and 52.4% of the patients who experienced a
workload due to low nurse-to-patient ratio and miscommunication with medical providers
too much paperwork to accomplish is difficult. (27). Not all patients have the same learning
It requires a high level of patience and nobility ability, and it could be due to language
to do it to every patient in the ER daily. Such differences, among others. It is believed that
patience and nobility are evident in this phrase good communication is an essential component
made by one participant, “…I make it an effort to in the dissemination of health education (28).
let them understand the importance of…” (P10). The subtheme “Patient’s Psychosocial
The subtheme “Language Barrier” is State” involves the mental and behavioral
reported by the participants as one factor that aspects of the patients at the time when they
interferes with giving health education in the were in the ER, which can pose as barriers to
ER. This usually occurs between health health education. When patients are
professionals and patients who do not have the transported from the ER to the operating room
same native language (23). The diversified in cases of emergencies, anxiety builds up with
languages between the ER nurses and the thoughts of wondering about the outcome of
the procedure. Nurses should explain to the
International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 274
patients and their significant others why such a In today's health systems, culture and
procedure should be done. The nurse has to health are vital to delivering quality care to
reduce anxiety by keeping the patients patients because it influences health beliefs and
informed. However, there's a possibility that behaviors and how health professionals
the more patients are informed, especially for respond to their patients in all facets of
considerably unknown procedures, the more maintenance (32), (33). Madeleine Leininger,
the patients will question its manner, whether the founder of transcultural nursing, had
it's painful or not, and even its cost, which may predicted that congruent cultural practice
result in increased anxiety. provides meaningful, satisfying, and beneficial
Patients who are “uncooperative" and patient care (34). Her transcultural nursing
those with a "lack of drive and willingness to learn” theory embodies the basis of much of the
are behaviors that may indicate a lack of interest application of cultural competence in
on the part of the patient. This is the result of the healthcare (35). She suggests that nurses must
thesis done by Devinney (19), wherein the Lack maintain a broad, objective, and open attitude
of Patient Interest was among the three most when caring for patients with different cultures;
significant barriers to patient education in the that nurses should avoid seeing all patients are
emergency department. Similarly, Wingard (29) alike (33).
explains the need to capitalize on an The subtheme “Nurse’s Lack of
individual's learning readiness. There will be Knowledge” was mentioned by a participant in
times when patient education cannot occur this study. Participant 3 expressed that for him,
simply due to a lack of enthusiasm or interest. “whether the nurse is knowledgeable enough on a
An example is a patient who visited the ER for certain health topic" can pose difficulty in
a superficial laceration may be unreceptive to conducting health education in the ER. This is
discussing their eating or smoking habits with similar to a study was done by Livne et al. (36)
the nurse while being sutured by the physician. regarding barriers to patient education wherein
The subtheme “Patient’s Cultural Beliefs” insufficient professional knowledge and nurse
pertained to the rituals or other traditions of the skills were predicted as among the obstacles to
patients that the participants expressed as a difficulty communicating with patients. This
barrier to health education in the emergency barrier could be due to nurses not having an
room. The hospital where the participants work extended contact period with the patients they
is in a city known for its diversity in culture, encounter (22), especially when patients are for
with indigenous groups such as the Yakan, immediate surgery or referral to other hospitals.
Badjao, Tausug, Chavacano, and Bisaya. Most Insufficient knowledge here could also mean a
of the locals in this city prefer to maintain its lack of skills or health teaching strategies to use
cultural beliefs and local traditions. For in the ER and may challenge the competency of
instance, some of its locals, like the Yakans and the ER nurse.
Badjaos, believed that “tawal" would help them The emergency department is a fast‐
heal faster. paced, ever-changing environment that nurses
“Tawal” or incantation is a practice often must adapt. It requires them to have a higher-
recited in Arabic or Malay to bring about the than-normal ability to think critically, clinical
desired change in a physical or mental skills, prioritization skills, and communication
condition to heal a sickness or avert a storm skills (37). The complex and diverse patient care
(30). It is performed by a “Magtatawal” or needs pose a significant challenge to the
"Mangungubat" (folk curers) who are sought in competence of ER nurses, and they should be
times of illness. They are considered traditional aware of its impact on patient care outcomes
medical specialists who obtain their powers (38). The patient's safety may be compromised
through dreams or by the instruction of older if a nurse cannot provide such competence in
curers. They use herbs and prayers in their the emergency room (37). ER nurses should be
healing activities (31), which has led to some competent to differentiate patient status, do
members of the indigenous group relying independent nursing interventions, be able to
heavily on them rather than obtaining skilled anticipate orders from the doctors, and
medical help from a health professional.

International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3, June 20th, 2022 275
prioritize necessary care based on what is The authors offer their gratitude to the
happening in the emergency room. nurses who took part in this study, as well as
The subtheme “Lack of Infographic everyone else who aided them in accomplishing
Materials” was mentioned by Participant 10 as this research. Special thanks to Nadzra Igasan
one of the factors that serve as barriers for Sali.
nurses in conducting health education in the
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