Discharge Planning

Discharge instructions:

• Provide written discharge instructions; avoid use of medical abbreviations
• Review discharge instructions with patient and caregivers
• Answer questions, clarify unclear items, explain medical terms and directions
• Request that physician return to clarify patient education or information needs
• Involve family and significant others in interaction
• Explain rationale for prescribed medication (e.g., drug actions, side effects) – offer specific instruction with medication (e.g., “Do not drive while taking this medication”)
• Refer to specific community resources

Teaching Effectiveness:

• Results in positive behavior/attitude changes
• Ask patient to restate in own words (or mime/demonstrate)
• Test understanding of learning
• Better learning if related to something familiar
• Return demonstration
• Follow-up phone call
• Specific language – signs of infection
• Focus on behavior, avoid absolute words
• Positive feedback

Barriers:

• Lack of privacy, time, rapport, nurse knowledge
• Distractions, cognitive impairment
• Unable to secure community follow-up
• Physiological barriers – pain, age, critical illness, medication, cognition, sight/hearing deficits
• Psychological barriers – trust, anxiety, denial, depression, psychosis
• Sociocultural – language, ethnic background, education, literacy
• Motivation

Compliance:

• Patient has right to choose whether to follow nurse’s advice
• Compliance with teaching depends – Recall ability, Comprehension, Desire to comply, Ability to perform, Health care literacy

Follow-up Arrangements:

• Follow-up appointment with primary care provider or specialist (e.g., orthopaedic surgeon, obstetrician, diabetic nurse educator)
• Clinic appointment
• Return visit to the emergency department or hospital
• Home health care/visiting nurse/community paramedicine program
• Social service or case management referral
• Psychiatric facility or outpatient psychiatric program
• Substance abuse/alcohol detoxification centers
• Condition-specific patient and caregiver support groups