A little goes a long way for discharge
A little goes a long way for discharge
Quality instruction yields patient readiness
It's a fine line walked during discharge education marrying content with effectiveness of delivery, about which researcher Marianne Weiss, DNSc, comments, "A little key content delivered effectively is better than gallons of knowledge delivered in a way that overwhelms."
A review of the discharge teaching content given to patients versus what the patients feel they need reveals that a large majority – 89% think they were given too much information.[1] Being overwhelmed by too much education, rather than being carefully instructed on key coping skills to help in their recovery, can set patients up for readmission, according to Weiss, of the Marquette University College of Nursing in Milwaukee.
"Too often, we focus on the content [of discharge instruction] itself," Weiss says. "Our studies show that how that content is delivered to the patient is at least as important as the content itself."
According to findings the college researchers published in 2007, the quality of the delivery of discharge teaching was the strongest predictor of patients' discharge readiness.[2] One hundred forty-seven medical-surgical patients participated in the study, which examined patient characteristics, hospitalization factors, and nursing practices prior to hospital discharge. Discharge readiness was measured by the Readiness for Hospital Discharge Scale, a tool in development by Weiss, administered four hours before discharge.
"It's all about perception," Weiss explains. "The insurance company and the [medical team] can feel one way about it, but if the patient himself or herself doesn't feel ready, the likelihood increases that that patient will be readmitted."
Feeling "ready" for discharge isn't a matter of feeling recovered so much as it is that the patient feels prepared to handle the expected and unexpected issues that arise during recovery.
Criteria for designation as critical access hospital The hospital:
Source: Centers for Medicare & Medicaid Services |
"In hospital-based case, probably our focus on content has become paramount," Weiss continues. "What we need to be doing is preparing patients with useful information about handling the realities of the situations they'll be experiencing."
She says that the role of discharge planners is to give the patient the information he or she needs most, and to teach the patient how to use it to problem-solve on their own.
"If they are feeling overwhelmed with information that they don't even have time to read, and they can't cope with all the things that are going on, they are more likely to be readmitted," Weiss says. In examining adult surgical patients' readiness for discharge, researchers learned that too much content overwhelmed the patients, and that feeling of being overwhelmed diminished the quality of the education.
"When we look at the quality of discharge teaching, we ask, How do we build confidence so they can manage on their own?" Weiss explains. "The knowledge is one piece of that, but it's important to teach the right amount of knowledge and how to use it."
Research done by Weiss and her colleagues at Marquette on patients' perception of discharge information also reveals sociodemographic dif-ferences in what education patients need at discharge, versus what they think they receive and what they feel they should be getting.[1]
White patients said they needed less information than nonwhite patients believe they need; patients who had been hospitalized previously and cardiac patients felt they were given more education at discharge than they were at earlier hospital discharges.
Different patients, no matter what the setting, will require different levels and amounts of discharge education, and Weiss stresses including others – family members, caregivers, friends – in discharge preparation.
"With the schedules nurses and patients are on, we are often finding those [educational] moments when we can, and often family members aren't there because they haven't been asked to be there," she says. "Family members are a part of the discharge preparation, and it's important that they be there because they are a part of managing the realities of being home after discharge from the hospital and of coping with those expected and unexpected situations that arise during recovery."
References
1. Maloney LR, Weiss ME. Patients' perceptions of hospital discharge informational content. Clin Nurs Res 2008;3:200-219.
2. Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec 2007;21:31-42.
Sources
For more information, contact:
- Marianne Weiss, DNSc, Associate Professor, Wheaton Franciscan Healthcare; St. Joseph/Sister Rosalie Klein Professor.
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