Table 3 Experts’ agreement about developed standards for patient education in NLCs

Structure

Standard 1: The head and director of the hospital, the director of nursing, the health education supervisor, and the head nurse of the clinic cooperate in establishing and supervising the Nurse-led clinic (NLC).

27 (77.1)

6 (17.1)

-

2 (2.9)

-

33 (94.2)

Standard 2: The patient education committee in the hospital has been formed with the participation of the head and director of the hospital, the nursing director, the health education supervisor, the head nurse of the clinic, and educating nurses in the NLC.

25 (71.4)

8 (22.9)

-

1 (2.9)

-

33 (94.3)

Standard 3: The hospital has defined the mechanism of interdisciplinary cooperation in patient and family education in the NLC.

27 (77.1)

5 (14.3)

-

2 (5.7)

-

32 (91.4)

Standard 4: The hospital has specified and announced the role and duties of the nurse, physician, and non-professional staff of the clinic (secretary, guard, etc.) regarding the activities of the health education nursing clinic.

23 (65.7)

6 (17.1)

2 (5.7)

3 (8.6)

-

29 (82.8)

Standard 5: A job description for the educating nurse in NLC is exist and available.

25 (71.4)

5 (14.3)

2 (5.7)

2 (5.7)

-

30 (85.7)

Standard 6: The hospital provides counseling services for nursing educators in patient education (the possibility of contacting and consulting with medical and nursing professors, books, and updated print and online instructions) to answer patients’ questions.

25 (71.4)

5 (14.3)

2 (5.7)

2 (5.7)

-

30 (85.7)

Standard 7: The hospital has provided the possibility of participating nursing educators in the NLC in codified patient education courses, health literacy, self-care, and self-management.

25 (71.4)

7 (20.0)

-

2 (5.7)

-

32 (91.4)

Standard 8: The hospital selects educating nurses in the NLC based on their competencies

26 (74.3)

6 (17.1)

-

2 (5.7)

-

32 (91.4)

Standard 9: The hospital selects the educating nurses in the NLC based on their meta-competencies.

28 (80.0)

2 (5.7)

1 (2.9)

1 (2.9)

2 (5.7)

30 (85.7)

Standard 10: The hospital provides the standard physical environment for the NLC.

25 (71.4)

7 (20.0)

1 (2.9)

1 (2.9)

-

32 (91.4)

Standard 11: The hospital provides training equipment, facilities, and educational assistance tools based on patients’ and their families’ educational needs and preferences.

27 (77.1)

5 (14.3)

-

1 (2.9)

-

32 (91.4)

Standard 12: The hospital has provided the necessary facilities for patients to access the NLC.

27 (77.1)

5 (14.3)

-

1 (2.9)

-

32 (91.4)

Standard 13: In the operational planning of the hospital, planning has been done for the development of training and counseling services in the NLC.

27 (77.1)

5 (14.3)

-

1 (2.9)

-

32 (91.4)

Process

Standard 1: The target group of patient education in NLCs is determined based on the type of disease and the number of patients referred to the hospital’s outpatient clinics.

14 (40.0)

13 (37.1)

3 (8.6)

3 (8.6)

1 (2.9)

27 (77.1)

Standard 2: The hospital uses the referral form to refer patients from the physician and inpatient wards to the NLCs.

20 (57.1)

7 (20.0)

4 (11.4)

3 (8.6)

-

27 (77.1)

Standard3: The hospital plans to improve the performance of the NLCs in serving clients and the community (improving the number of referring patients).

23 (65.7)

9 (25.7)

1 (2.9)

1 (2.9)

-

32 (91.4)

Standard 4: The nurse, if necessary, refers the patient to the NLCs in specialized hospitals and related social organizations.

19 (54.3)

10 (28.6)

1 (2.9)

4 (11.4)

-

29 (82.9)

Standard 5: The working hours of the NLCs should be daily and regular, preferably during the attendance hours of the hospital clinic physicians.

23 (65.7)

4 (11.4)

1 (2.9)

5 (14.3)

1 (2.9)

27 (76.8)

Standard5: nurses in the NLCs work based on their job descriptions.

14 (40.0)

13 (37.1)

3 (8.6)

3 (8.6)

1 (2.9)

27 (77.1)

Standard 7: Planning the performance of the NLCs as a team in the hospital and coordination with the Vice-Chancellor of the University, taking into account the specialty of the hospital, the number of patients referred to the hospital clinic, and the attendance plan of physicians

15 (42.9)

10 (28.6)

4 (11.4)

4 (11.4)

1 (2.9)

25 (71.5)

Standard 8: The University Vice-Chancellor is responsible for overseeing the establishment and operation of NLCs in hospitals.

23 (65.7)

7 (20.0)

1 (2.9)

2 (5.7)

1 (2.9)

30 (85.7)

Standard 9: The hospital performs its duties in the field of setting up and operating NLCs.

22 (62.9)

7 (20.0)

1 (2.9)

3 (8.6)

-

29 (82.9)

Standard 10: The hospital director and manager use appropriate methods to engage physicians to refer patients to Ns.

19 (54.3)

8 (22.9)

1 (2.9)

4 (11.4)

1 (2.9)

27 (77.2)

Standard 11: program and training materials (annual) should be reviewed.

30 (85.7)

3 (8.6)

-

1 (2.9)

-

33 (94.3)

Standard 12: The hospital has determined the cost of patient education.

19 (54.3)

7 (20.0)

1 (2.9)

3 (8.6)

3 (8.6)

26 (74.3)

Standard 13: Needs assessment and training priorities for patients referred to the NLCs are performed at appropriate intervals in the hospital.

20 (57.1)

11 (31.4)

2 (5.7)

1 (2.9)

-

31 (88.5)

Standard 14: Learning Objectives for Patient Education in the NLCs are set by the care team in a codified educational program.

22 (62.9)

7 (20.0)

2 (5.7)

1 (2.9)

2 (5.7)

29 (82.9)

Standard 15: Develop an educational program with a precise definition of behavioral and educational goals for groups of patients.

21 (60.0)

6 (17.1)

5 (14.3)

1 (2.9)

1 (2.9)

27 (77.1)

Standard 16: The content of patient education is prepared based on a well-designed program in the hospital, educational goals, target group and, the group needs assessment.

27 (77.1)

6 (17.1)

1 (2.9)

-

-

33 (94.2)

Standard 17: Nurses provide appropriate training materials to patients to complete their training.

25 (71.4)

7 (20.0)

-

1 (2.9)

-

32 (91.4)

Standard 18: Patient education record (needs assessment, inclusive, education method, duration of education, feedback received from education) is recorded in the education form.

25 (71.4)

7 (20.0)

1 (2.9)

1 (2.9)

-

32 (91.4)

Standard 19: Patient education documentation must be accurate, clear and legal.

26 (74.3)

6 (17.1)

-

2 (5.7)

-

32 (91.4)

Standard 20: Evaluation of training programs must be accurate and clear.

27 (77.1)

4 (11.4)

1 (2.9)

-

-

31 (88.5)

Standard 21: Codified training programs are evaluated annually.

23 (65.7)

8 (22.9)

1 (2.9)

2 (5.7)

-

31 (88.6)

Standard 22: patient education working group/committee prioritizes follow-up for patients.

16 (45.7)

12 (34.3)

4 (11.4)

-

1 (2.9)

28 (80.0)

Standard 23: The Patient Education Working Group / Committee plans and acts to follow patients.

18 (51.4)

12 (34.3)

3 (8.6)

-

-

30 (85.7)

Standard 24: Patient education needs assessment is performed and recorded by the nurse for each patient based on the educational needs assessment.

21 (60.0)

7 (20.0)

3 (8.6)

2 (5.7)

1 (2.9)

28 (80.0)

Standard 25: Patient education is prioritized based on individual needs assessment and a well-designed program.

23 (65.7)

8 (22.9)

3 (8.6)

-

-

31 (88.6)

Standard 26: Teaching patients is a combination of face-to-face and absentee methods, taking into account the preferences of patients and families.

23 (65.7)

11 (31.4)

-

-

-

34 (97.1)

Standard 27: Patient education is done as a team with the participation of all caring team members in education.

20 (57.1)

7 (20.0)

4 (11.4)

3 (8.6)

-

27 (77.1)

Standard 28: Patient education is based on respect for patient privacy, confidentiality, and respect for patients’ values ​​and beliefs.

30 (85.7)

4 (11.4)

-

-

-

34 (97.1)

Standard 29: Patient education should be tailored to the patient’s condition, for the patient’s time, as soon as possible, by the patient’s physical condition, and when they can concentrate.

26 (74.3)

7 (20.0)

-

-

1 (2.9)

33 (94.3)

Standard 30: The duration of patient education in the health education clinic is determined depending on the patient’s condition.

28 (80.0)

4 (11.4)

1 (2.9)

-

-

32 (91.4)

Standard 31: There is evidence that the patient and family are involved in determining educational needs and choosing teaching methods.

23 (65.7)

8 (22.9)

1 (2.9)

1 (2.9)

1 (2.9)

31 (88.6)

Standard 32: Patient’s understanding of education is assessed in the NLCs using patient questioning, observation and return-demonstration methods.

25 (71.4)

9 (25.7)

-

-

-

34 (97.1)

Standard 33: Patient perception of education is reviewed and recorded at the end of the training session.

26 (74.3)

8 (22.9)

-

-

-

34 (97.2)

Standard 34: The hospital has developed an appropriate process and protocol for preparing, distributing and storing educational materials (pamphlets, multimedia).

25 (71.4)

7 (20.0)

2 (5.7)

-

-

32 (91.4)

Standard 35: The hospital uses the appropriate process to prepare standard educational materials for compiling educational content.

22 (62.9)

9 (25.7)

1 (2.9)

-

1 (2.9)

31 (88.6)

Standard 36: Various methods of distributing educational materials according to hospital conditions and patients’ preferences are used (electronic and print distribution).

24 (68.8)

5 (14.3)

2 (5.7)

1 (2.9)

1 (2.9)

29 (83.1)

Standard 37: The hospital uses appropriate training materials to educate patients in the NLCs.

25 (71.4)

6 (17.1)

2 (5.7)

-

-

31 (88.5)

Outcome

Standard 1: Patients referred to the NLC know the risk factors for chronic diseases, complications and prevention methods.

25 (71.4)

7 (20.0)

-

1 (2.9)

-

32 (91.4)

Standard 2: Patients referred to the NLC know ways to improve and maintain a healthy lifestyle.

24 (68.6)

7 (20.0)

-

1 (2.9)

1 (2.9)

31 (88.6)

Standard 3: Referrals to the NLC make informed decisions to control their illness and lead a healthy lifestyle based on cultural and religious values ​​and socioeconomic status.

21 (60.0)

9 (25.7)

1 (2.9)

1 (2.9)

1 (2.9)

30 (85.7)

Standard 4: The physical, mental and emotional health of patients referred to the NLC is promoted.

26 (74.3)

5 (14.3)

1 (2.9)

1 (2.9)

-

31 (88.6)

Standard 5: The hospital examines the short-term and long-term consequences of providing education and counseling services to patients and their families.

24 (68.6)

8 (22.9)

-

1 (2.9)

-

32 (91.5)