Patient education among nurses: bringing evidence into clinical applicability in Iran

  • Hossein Karimi Moonaghi RN Ph.D. Professor, Mashhad University of Medical Sciences, Mashhad, Iran. email:
  • Amir Emami Zeydi RN, PhD Candidate. Mashhad University of Medical Sciences, Mashhad, Iran. email:
  • Amir Mirhaghi RN, PhD. Professor, Mashhad University of Medical Sciences, Mashhad, Iran. email:
Keywords: Patient education as topic, health services, nurses, Iran.


Objective. The aim of this study was to present a comprehensive review of the literatures describing barriers and facilitators of patient education (PE) perceived by Iranian nurses in order to explain clinical applicability of patient education.

Methods. Review of the literature was undertaken using the international databases including PubMed/Medline, Scopus, ScienceDirect, as well as Google Scholar. Also, Persian electronic databases such as Magiran, SID and IranMedex were searched. Electronic databases were searched up from conception to September 2014 using search terms: "patient education", " patients education", "patient teaching", "patient training", "nurse", " nurses", " nursing", " and "Iran". Only studies were included that were related to barriers and facilitators of PE among Iranian nurses.

Results. Twenty-seven studies were included. The main influential barriers were categorized into three major areas: 1) Nurse-related factors: nursing shortage 2) Administration-related factors: unsupportive organizational culture, and 3) Patient-related factors: low compliance. The most perceived facilitators were recognized as “increasing, selecting and training special nurses for providing PE” and “providing PE courses for nurses and appropriate facilities for PE”.

Conclusion. Iranian nurses encounter barriers in PE, and the most frequently encountered barriers were related to administration factors. These findings have implications for administrators and managers in health settings. In order to promote PE among nurses, administrators should create a supportive environment and use effective strategies to smooth the progress of PE by nurses in their practice in order to ensure optimal outcomes for patients.


How to cite this article: Karimi Moonaghi H, Emami-Zeydi A, Mirhaghi A.  Patient education among nurses: Bringing evidence into clinical applicability in Iran. Invest Educ Enferm. 2016; 34(1): 137-151

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(1) Karimi Moonaghi H, Hasanzadeh F, Shamsoddini S, Emamimoghadam Z, Ebrahimzadeh S. A comparison of face to face and video-based education on attitude related to diet and fluids: Adherence in hemodialysis patients. Iran J Nurs Midwifery Res. 2012;17(5):360-4.

(2) Park M. Nurses' perception of performance and responsibility of patient education. Taehan Kanho Hakhoe Chi. 2005;35(8):1514-21.

(3) Ghorbani R, Soleimani M, Zeinali M, Davaji M. Iranian nurses and nursing students' attitudes on barriers and facilitators to patient education: a survey study. Nurse Educ Pract. 2014;14(5):551-6.

(4) Visser A, Deccache A, Bensing J. Patient education in Europe: united differences. Patient Educ Couns. 2001;44(1):1-5.

(5) Friberg F, Granum V, Bergh A. Nurses’ patient-education work: conditional factors – an integrative review. J Nurs Manag. 2012; 20(2):170-86.

(6) Aghakhani N, Nia HS, Ranjbar H, Rahbar N, Beheshti Z. Nurses’ attitude to patient education barriers in educational hospitals of Urmia University of Medical Sciences. Iran J Nurs Midwifery Res. 2012;17(1):12-5.

(7) Mullen P, Mains D, Velez R. A meta-analysis of controlled trials of cardiac patient education. Patient Educ Couns. 1992;19(2):143-62.

(8) Strömberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. 2005; 7(3):363-9.

(9) Mazzuca S. Does patient education in chronic disease have therapeutic value? J Chronic Dis. 1982; 35(7):521-9.

(10) Mahmoudi H, Mohmmadi E, Ebadi A. Barriers to nursing care in emergency wards. Iran J Nurs Midwifery Res. 2013; 18(2):145-51.

(11) Mardanian Dehkordi L, Salahshorian A, Mohammad Alayha J, Hosseini F. Nurses` Perception of patient teaching, Enhancing and Inhibiting Factors. Iran J Nurs. 2005; 17(40):18-27.

(12) Bergh A, Karlsson J, Persson E, Friberg F. Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects. J Nurs Manag. 2012; 20(6):758-70.

(13) Borhani F. Nurses and nurse-Managers’ opinions about the importance of patients’ training barriers. J Qazvin U Med Sci. 2002; 5(4):84-90.

(14) Goudarzi Z, Khosravi K, Bahrani N, Vaskooii K, Valipourgavgany P, Ghoghaei S, et al. A study of professional nurses’ perceptions of factors affecting the process of client education. Hayat. 2004; 0(4):57-65.

(15) Honan S, Krsnak G, Petersen D, Torkelson R. The nurse as patient educator: perceived responsibilities and factors enhancing role development. J Contin Educ Nurs. 1998; 19(1):33-7.

(16) Heshmati Nabavi F, Vanaki Z. Nurses opinions and ranking of patients training barriers. Quarterly Journal of Kerman Faculty of Nursing and Midwifery. 2006; 1:47-52.

(17) Hekmatpou D, Anoosheh M, Alhani F. Pathology of Patient Education: A Qualitative Study. Iran J Nurs. 2007;20(49):51-60.

(18) Mazaheri E, Mohammadi R. Health personnel's opinions of Ardabil University of Medical Sciences about the aged patient training barriers. Dena. 2006;1(1):75-82.

(19) Abbasi M, Nouroozi M, Mehran N. Evaluation of the barriers to patients education from the nurses view point and providing a facilitators model in teaching hospitals of Qom University of Medical Sciences in 2007. Quar J Hosp. 2008; 7:13-6.

(20) Moridi G, Khaledi S, Barfi M. Education Inhibitory Factors and Facilitators in Sanandaj, Iran, 2007. Dena. 2009; 4(3-4):43-52.

(21) Ashghali-Farahani M, Mohammadi E, Ahmadi F, Maleki M, Hajizadeh E. Obstacles of Patient Education in CCU and Post CCU: A Grounded Theory Study. Iran J Nurs. 2009; 22(58):55-73.

(22) Aziznejad P, Zabihi A, Hosseini S, Bijani A. Nurses and Nurse Managers Opinions about the Patient’s Training Barriers. J Babol U Med Sci. 2010; 12(5):60-4.

(23) Rostami H, Montazam S, Ghahremanian A. Survey of Education Barriers from Nurses and Patients Viewpoint. Scientific J Hamadan Nurs Midwifery Fac. 2010; 18(1):50-5.

(24) Beiranvand S, Sheinijaberi P, Asadizaker M. Patient Education from the View Point of Nursing: The Main Executive Barriers. Aflak. 2010; 10(18-19):1-9.

(25) Hekari D, Mohammadzadeh R. Quality of patients’ education by nursing students and employment nurses and its effective factors in Tabriz hospitals in 2007-2008. Med Sci J Islamic Azad U. 2010;20(1):58-63.

(26) Mansour ghenaati R, Majidi S, Tabari R. Evaluation of staff nurses’ view point regarding the importance of the facilitators and barriers of patients education. Res Med Educ. 2011; 3:27-33.

(27) Haddad M. Viewpoints of employed nurses in hospitals of Birjand city regarding existing barriers in patient education. Mod Care J. 2011;8(3):152-8.

(28) Vahedian Azimi A, Payami Bosari M, Gohari Moghaddam K. A survey on nurses clinical problems in patient education. Bimonthly J Urmia Nurs Midwifery Fac. 2011; 9(4):295-305.

(29) Farahani M, Sahragard R, Carroll J, Mohammadi E. Communication barriers to patient education in cardiac inpatient care: A qualitative study of multiple perspectives. Int J Nurs Pract .2011; 17 (3):322-8.

(30) Vahedian Azimi A, Alhani F, Hedayat K. Barriers and Facilitators of Patient's Education: Nurses’ Perspectives. Iran J Med Educ. 2012; 11(6):620-34.

(31) Ghobadi A, Ghodsbin F, Majidipour P, Mohamadsalehi N. Study of barrier and facilitator factors of patient education in clinical nurse's point of view in selected hospitals of Shiraz University of medical science. J Clin Res Paramed Sci. 2012; 1(1):8-15.

(32) Farahani M, Mohammadi E, Ahmadi F, Mohammadi N. Factors influencing the patient education: A qualitative research. Iran J Nurs Midwifery Res. 2013; 18(2):133-9.

(33) Sultani A, Hadavi M, Heydari S, Shahabinezhad M. Barriers to Patient Education Based on the Viewpoints of Nurses and Nurse Managers in Hospitals of Rafsanjan University of Medical Sciences, 2008. J Rafsenjan U Med Sci. 2013; 12(4):309-18.

(34) Alavi M, Irajpour A, Giles T, Rabiei K, Sarrafzadegan N. Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study. Contemp Nurse. 2013; 44(2):204-14.

(35) SaeidPour J, Ghazi Asgar M, Rahmani H, Khoshkho M. Surveying Doctors and Nurses Viewpoints on Enhancing and Inhibiting Factors of Educating Patients. Hosp J. 2014; 13(1):61-7.

(36) Dehghani A, Orang M, Abdollahyfard S, Parviniyan nasab A, Vejdani M. Barriers to Patient Education in Clinical Care; Viewpoints of Nurses. Iran J Med Educ. 2014; 14(4):332-41.

(37) Esteki R, Mahmoudirad G. Nurses' Perception of Patient Education in Critical Care Units: A Content Analysis. J Qual Res Health Sci. 2014; 3(2):126-36.

(38) Barber-Parker E. Integrating patient teaching into bedside patient care: a participant-observation study of hospital nurses. Patient Educ Couns. 2002; 48(2):107-13.

(39) Tse K, So W. Nurses' perceptions of preoperative teaching for ambulatory surgical patients. J Adv Nurs. 2008; 63(6):619-25.

(40) Marcum J, Ridenour M, Shaff G, Hammons M, Taylor M. A study of professional nurses' perceptions of patient education. J Contin Educ Nurs. 2002; 33(3):112-8.

(41) Raffray M, Semenic S, Osorio Galeano S, Ochoa Marín S. Barriers and facilitators to preparing families with premature infants for discharge home from the neonatal unit. Perceptions of health care providers. Invest Educ Enferm. 2014; 32(3):379-92.

(42) Barrett C, Doyle M, Driscoll S, Flaherty K, Dombrowski M. Nurses' perceptions of their health educator role. J Nurs Staff Dev. 1990; 6(6):283-6.

(43) Mehrdad N, Salsali M, Kazemnejad A. The spectrum of barriers to and facilitators of research utilization in Iranian nursing. J Clin Nurs. 2008; 17(16):2194-202.

patient education: A qualitative research. Iran J Nurs Midwifery Res. 2013; 18(2):133-9.

(44) Jafaraghaee F, Mehrdad N, Parvizy S. Influencing factors on professional commitment in Iranian nurses: A qualitative study. Iran J Nurs Midwifery Res. 2014; 19(3):301-8.

(45) Huey F, Hartley S. What keeps nurses in nursing. 3,500 nurses tell their stories. Am J Nurs. 1988;88(2):181-8.

(46) Aiken L, Clarke S, Sloane D, Sochalski J, Busse R, Clarke H, et al. Nurses' reports on hospital care in five countries. Health Aff (Millwood). 2001; 20(3):43-53.

(47) Griffith C, Wilson J, Desai N, Rich E. House staff workload and procedure frequency in the neonatal intensive care unit. Crit Care Med. 1999; 27(4):815-20.

(48) Casey D. Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses. J Clin Nurs. 2007; 16(3):580-92.

(49) Bergh A, Persson E, Karlsson J, Friberg F. Registered nurses' perceptions of conditions for patient education--focusing on aspects of competence. Scand J Caring Sci. 2014; 28(3):523-36.

(50) Moret L, Rochedreux A, Chevalier S, Lombrail P, Gasquet I. Medical information delivered to patients: discrepancies concerning roles as perceived by physicians and nurses set against patient satisfaction. Patient Educ Couns. 2008;70(1):94-101.

(51) Vafaee-Najar A, Ebrahimipour H, Shidfar M, Khani-Jazani R. Patient education services and the organizational factors affecting them at teaching hospitals affiliated with Mashhad University of Medical Sciences (MUMS), 2008. J Mens Health. 2012; 9(4):230-7.

(52) Heidari M, Norouzadeh R. Factors affecting patient education from cultural perspectives. J Adv Med Educ Prof 2013; 1(4):136-9.

(53) Tortumluoglu G, Okanli A, Ozyazicioglu N, Akyil R. Defining cultural diversities experienced in patient care by nursing students in eastern Turkey. Nurse Educ Today. 2006; 26(2):169-75.

(54) Knoerl A, Esper K, Hasenau S. Cultural sensitivity in patient health education. Nurs Clin North Am. 2011; 46(3):335-40.

(55) Jordan J, Buchbinder R, Osborne R. Conceptualising health literacy from the patient perspective. Patient Educ Couns. 2010; 79(1):36-42.

(56) Beagley L. Educating patients: understanding barriers, learning styles, and teaching techniques. J Perianesth Nurs. 2011; 26(5):331-7.

(57) Norouzi H, Tohidi S, Karimi Moonaghi H, Behnam Vashini H. The Comporison of the Effects of the Lecture and Self-Learning Module on Nurses, Teaching-Competency to Cardiac Patient Education. J Mazandaran U Med Sci. 2014; 24(1):197-202.

(58) Mirhaghi A, Karimi-Moonaghi H, Sharafi S, Emami-Zeydi A. Role modeling: A Precious Heritage in Medical Education. Sci J Fac Med Niš. 2015; 32(1):31-42.

(59) Inott T, Kennedy B. Assessing learning styles: practical tips for patient education. Nurs Clin North Am. 2011; 46(3):313-20.

(60) Tilley J, Gregor F, Thiessen V. The nurse's role in patient education: incongruent perceptions among nurses and patients. J Adv Nurs. 1987; 12(3):291-301.

How to Cite
Karimi Moonaghi, H., Emami Zeydi, A., & Mirhaghi, A. (2016). Patient education among nurses: bringing evidence into clinical applicability in Iran. Investigación Y Educación En Enfermería, 34(1). Retrieved from