Table 2.

Extracted challenges of the process of patient education

Challenge	Sub-challenge	Code	Challenge	Sub-challenge	Code
Challenges related to human resources (HR)	The patient does not listen carefully (The patient does not follow the educators & does not pay due attention to the educations)	HR1	Challenges related to the work environment and its condition (E)	The educational films provided for the classes are not suitable in terms of duration, quality, and content	E1
	The patient does not understand the meaning of education content	HR2		The patient does not have the training booklet throughout hospitalization	E2
	The patient forgets	HR3		Medical education information is often forgettable to the patient	E3
	The patient is illiterate	HR4		The nurse does not have the time to evaluate the effectiveness of the provided education	E4
	The patient does not understand the standard language	HR5		Change in the patient’s behavior (attitude and belief) is not measurable in the short period of hospitalization	E5
	The patient is not aware of the importance of the educational subject	HR6		The education room or the inpatient ward room is small, and there are not adequate group classrooms	E6
	The patient is not aware of his/her rights	HR7		In crowded classes, temperature and air circulation are not suitable	E7
	The patient does not accept the illness, or the mental problems resulting from the illness decrease the educational effectiveness	HR8		Different candidates are chosen for each individual during the education time by the nurse/physician	E8
	The patient does not consider the information provided by the doctor/nurse as education	HR9		Educational tools, including booklet and brochure, are not interactive	E9
	The patient doesn’t understand the medical terms used by the treatment team	HR10		Educational tools are not used appropriately	E10
	Some of the patient's caregivers request for the same education that has already been given to the patient	HR11		There are no appropriate visual tools for education	E11
	The patient's family does not want her/him to know about the disease or the treatment	HR12		There is no continuous educational platform (covering educational tools or an educator) inside or outside the health center when needed	E12
	The nurse is too busy to allocate enough time to educational affairs	HR13		New tools & technologies are not used in patient education	E13
	The nurse emphasizes clinical practices more than education	HR14	Challenges related to management and system (M)	Lack of effective interaction during education and lack of patient involvement	M1
	In face-to-face education, it is not possible to supervise the education process by a qualified person. The confirmation form of education is completed by the nurse; therefore, it is impossible to make sure of transmitting all the necessary information	HR15		Incomprehensive and incomplete educational protocols (the nurse authority is restricted to transmitting clinical information by protocols and rules)	M2
	The nurse authority is limited in transmitting some educational information	HR16		The patient's mental status is not considered during the education	M3
	Some nurses have low communicational skills	HR17		Patients are not grouped based on their physical weakness and disability	M4
	Different types of treatment and the possible complication are not explained by the medical team to the patient	HR18		Due to a lack of pre-awareness in the outpatient treatment and hospitalization stage, the patient does not have enough physical & mental readiness	M5
	The medical team does not provide an explain while prescribing aggressive procedures	HR19		The patients who do not attend the educational classes due to their specific conditions or period of the treatment will lose group education	M6
	Oral education is not presented by the medical team during the discharge	HR20		There is no rule for disambiguation and pre-procedure education for non-invasive procedures	M7
	In the surgery department, there is less educational communication between the surgeon or her/his assistants and patient	HR21		The focus of the evaluation system is more on writing reports than on clinical practices and communication between nurses and patients	M8
	The experience & educational skills of doctors are different and, in some cases, inadequate	HR22		There are no good plans for the patients’ other diseases	M9
	Being too busy, the doctor cannot allocate enough time to talk with the patient	HR23		The education of preventing frequent disorders in ICU is not sufficiently considered	M10