CHAPTER 51. Patient Discharge Education in the Phase II Setting
Nancy Saufl
OBJECTIVES
At the conclusion of this chapter, the reader will be able to:
1. Utilize the nursing process in providing patient, family, and/or accompanying responsible adult appropriate education (assessment, nursing diagnosis, planning, intervention, and evaluation).
2. Review The Joint Commission’s patient education standards.
3. Identify postoperative education needs for the patient, family, and/or accompanying responsible adult.
4. Identify learning deficits of the patient, family, and/or accompanying responsible adult.
5. Develop the education plan for the patient, family, and/or accompanying responsible adult based on learning deficits and needs.
6. Define the postoperative education needed for patient, family, and/or accompanying responsible adult.
7. Define documentation standards for education of patient, family, and/or accompanying responsible adult.
I. REVIEW OF THE JOINT COMMISSION’S (TJC) PATIENT EDUCATION STANDARDS
A. “The goal of patient and family education is to improve patient health by promoting healthy behavior and involving the patient in care and care decisions.”
B. Expectations
1. Provide the patient and family or accompanying responsible adult with information that will enhance their knowledge and the skills necessary to promote recovery and improve function.
2. Provide the patient with education and training as appropriate.
a. Assessed needs
b. Abilities and learning preferences
c. Readiness to learn
3. Consider barriers in education assessment.
a. Cultural
b. Religious
c. Physical
d. Cognitive limitations
e. Language
f. Financial
4. Educate patients about:
a. Their medications according to their needs
b. Equipment and supplies and means of obtaining them
5. Teach patients regarding foods and diets appropriate to illness as well as possible food-drug interactions.
6. Provide patients with information on obtaining follow-up care and accessing community resources.
7. Provide patients with education about pain management as part of treatment.
8. Provide patients with information about their rights and responsibilities.
a. Patient’s Bill of Rights acknowledges the patient’s right to participate in his or her own health care.
b. TJC “Speak Up” initiative: urges patients to take a role in preventing health care errors by becoming active, involved, and informed participants
9. Provide discharge instructions that contain information about:
a. Diet
b. Activity
c. Medications
d. Follow-up care
e. Contact number if the patient has questions
10. Document patient education provided to patient and family in:
a. Verbal form
b. Written form
11. Promote the education process among the multidisciplinary health care team members.
a. Include the opportunity for health care providers to ask questions.
C. Patient’s rights information emphasizes the importance of educating patients regarding ongoing health care requirements after discharge.
D. When the nurse evaluates the patient’s discharge status, the American Society of PeriAnesthesia Nurses (ASPAN) states that the nurse must:
1. Review the discharge instructions with the patient, family, and accompanying responsible adult as appropriate.
2. Assess the patient and home care provider’s knowledge of the discharge instructions.
3. Ensure that written discharge instructions have been given to the patient/accompanying responsible adult.
II. EDUCATION ASSESSMENT
A. Use information collected through:
1. Needs assessment (see Chapter 15)
2. Health history
3. Interview with patient, family, and/or responsible accompanying adult
B. Determine patient’s preferred methods of learning (see Chapter 3).
C. Consider the patient’s, family’s, and/or responsible accompanying adult’s understanding of the surgical or invasive procedure and the process.
D. Evaluate
1. Health beliefs
2. Practices
3. Economic factors
4. Cultural factors
E. Ascertain the patient’s support system.
F. Determine:
G. Determine home care and postoperative education needs based on:
1. Patient learning and knowledge deficits
2. Method/type of anesthesia
3. Procedure
a. Learning needs and deficits are determined by:
(1) Anticipated diet
(2) Activity
(3) Potential emergency conditions
(4) Dressing and wound care
(5) Medication reconciliation
(a) Medications prescribed for postoperative period
(b) Routine home medications
(6) Follow-up care
(7) Home care requirements
(8) Typical recovery progression
III. NURSING DIAGNOSIS
A. Identify patient’s, family’s, and/or responsible accompanying adult’s learning deficits.
1. Learning needs can be designated in two ways.
a. Primary concerns or problems
b. As the etiology of a nursing diagnosis associated response to health alterations or dysfunction
c. Nursing diagnosis from North American Nursing Diagnostic Association (NANDA) and ASPAN’s Perianesthesia Data Elements (PDE) may be used.
(1) Knowledge deficit: deficiency in cognitive knowledge or psychomotor skills concerning the condition or treatment plan, or information-seeking behaviors
(2) Health-seeking behavior: the state in which an individual in stable health actively seeks ways to alter personal health habits and/or the environment in order to move toward a higher level of wellness
(3) If the knowledge deficit is considered the etiology, then the nursing diagnosis will be identified as the “risk for …” (risk for infection …).
d. Examples of nursing diagnosis may include the following:
(1) Altered skin integrity related to (R/T) surgical wound
(2) Potential for infection at surgical site
(3) Alterations in comfort—pain
(4) Alterations in comfort—nausea and vomiting
(5) Self-care deficit
(6) Actual or perceived loss of privacy or dignity
(7) Risk of hemorrhage
(8) Anxiety R/T fear of home care without nursing support, separation from family
(9) Potential for injury R/T faintness, weakness, fatigue, prolonged regional block, altered sensory perception
(10) Altered thought processes and/or memory loss R/T sedation and analgesia
(11) Ineffective airway clearance
(12) Potential for aspiration
(13) Ineffective breathing patterns, respiratory depression R/T sedation, anesthesia, positioning, pain, increased respiratory secretions, vomiting, or untoward reactions to medications or local anesthetics
(14) Potential alteration in tissue perfusion, cardiovascular instability
e. Outcome goals, nursing interventions, and resources determined as part of the patient discharge education plan may be R/T the preceding examples or other identified problems.
(1) Education provided must address the outcome goals and nursing interventions to provide consistency and safe care.
IV. PLANNING
A. Develop the patient’s, family’s, and responsible accompanying adult’s education plans based on learning deficits and needs.
1. Formulate the teaching plan and modify as needed.
a. Be conscious of sensory or language barriers.
b. Discharge planning begins with initial contacts, preoperative assessment, and evaluation.
2. Identify patient discharge education materials.
a. Base planning of materials on “need to know versus nice to know.”
b. Generic information and procedure-specific information
c. Large print size—12-point font or larger
(1) Sans serif or serif fonts (Arial, Tahoma, etc.)
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