Critical appraisal and summary presentation

Introduction and background

The period of discharge from hospital is a complex and important time for a patient during their journey of heath care continuum (Waniga et al., 2016). Many patients experience anxiety and apprehension due to their inability to comprehend the discharge instructions. Not all patients fully understand the discharge instructions, so remainconfused (Marcus,2014).Discharge completed by nurse in haste   and poor comprehension by the patients may lead   to more medication errors (Newnham et al., 2017). The misappropriate communication may lead to necessity of unnecessary telephone calls to clarify their doubts repeatedly. The over-all perceptions of the patients become marked by confusion and unsatisfaction. Post-discharge care at homeis adversely impacted leading to post-discharge complications, adverse drug events and increased rate of rehospitalization (Waniga et al., 2016).

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Timely, accurately and appropriately conveyed discharge education is vital for continuing post-discharge health care and for maintaining communicationlinks among the patients, primary care nurses and the hospitals(Newnham et al., 2017).  A high-quality discharge education helps the patient in speeding the healingprocess. The patients are encouraged to learn self-care skills and new lifestyle changes.  With effective discharge education, the rate of readmission in emergency care is prevented. The patient’s education can be initiated right after admission in the unit by providing training in systematic planned manner (Yilmaz et al., 2019). Communication is considered complete when the patient receives and understands accurate, timely and unambiguous messages from the nurse that enable them for managing their own health (Marcus,2014).

While verbal instructions are part of the patient education, they should be delivered in a fashion that enhances patient’s commitment, learning, comprehension and retention (Marcus,2014). According to Newnham et al. (2017), information technology like computer-generated and video-based discharge communication practices are preferred by both the patients and the nurses. The patients and their family members gain complete knowledge of the disease process and discharge instructions. Therefore, while providingthe best enhanced discharged education, it is important to explore what are the communication practices that are preferred by the patients and whatpractices areleading to negative experiences(Newnham et al., 2017).

 

Significance of study

The impact of discharge instruction provided by the nurse on a patient’s experience is not fully exploredin nursing literature. It is important to know if the nurse-generated discharge education has constructive impacts on the patients’ perceptions andif the patients are fully satisfied with the instructions. This insight from patient’s perception will assist the discharging nurse infurther improving the discharge process further to achieve patient’s full satisfaction (Waniga et al., 2016). In the proposed research, the discharge guidelines for the nurses are enhanced and standardized   to help the patients understand the instruction easily and completely to result in improved experience and satisfaction. Patients’ satisfaction will be measured by using survey tools having relevant questions that the patients answer on follow-up visits. The discharge experience will include speed of discharge process, qualityof instructions for homecare,providing arrangement of home care services, personal issues and overall assessment (Waniga et al.,2016).

 

Research question

What is the impact of the enhanced nurse-led discharge education on patient’s perception, satisfaction and comprehension in?

To explain the question using PICO tool in qualitative design:

P or Population: the patients who are provided nurse-generatedenhanced discharge instructions

I or Issue:to explore impact of discharge educationon patients’experiences,satisfaction, and comprehension

C or Comparison: nil

O or Outcome: satisfaction and experiences

 

Search Strategy

First of all, relevant electronic databases will be searched. Regarding rationale for selecting the databases, CINAHL Completeor theComplete Index of Nursing and Allied Health Literature provides full-text access to the resources and academic peer reviewed articles of high-quality includingjournals.PubMed is a database that is operated by the US National Library of Medicine. This database provides abstracts and full articles from journals and textbooks.Cochrane Library isa collection of databases.The research will use Cochrane Database of Systematic Reviews (CDSR)and Cochrane Central Register of Controlled Trials (CENTRAL).MEDLINE through Ovid is a premier bibliographic database that encompasses medicine, nursing and the health care system(UIC Education 2020).Besides this, Google Scholar also provides full text articles related to medicine and nursing.Google Scholar providescitations, related articles, and additional publications by the same author. The articles can be downloaded (Online Research Guide, 2020).

The key words and the key phrases derived from the research question will be used for searching the literature to get relevant articles. Accurate synonyms and index terms will be used to expand the search. The key words and phrase in this studywill be such as nurse-led discharge  education, nurse-generated discharge instructions, discharge,verbal  education,patient’s satisfaction, comprehension, experience,compliance, post-discharge complication, rehospitalization , adverse  events, medication errors .With use of Boolean operator AND and OR, the search is expanded. For example:patients AND family, perceptions OR experiences,education ORinstructions. The search is refined by using Boolean operator NOT. For example, in this study, patients with psychological illness are excluded therefore search phrase will be “patients with general illness NOT psychological”. The key words will be modified asrequired.Patient can be replaced by client and consumer.Satisfaction can be modified by comprehension andpositive experiences. The bibliographies of selected articles can be searched to access more valuable research work papers

Filters will be used to refine the search, suchas articletypes, time of publication, text availability, language and journal categories. The filters will help in selecting the relevant articles and avoiding the non-relevant papers  according to inclusion exclusion criteria (Grewal et al, 2016).The filters in this search are Englishlanguage, time of publication (not older than five years).The search will include only peer-reviewed primary articles andsecondary articles like systematic reviews and metanalysis.The commentaries, case reports, editorials and personal communication are excluded.

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