Title: The Impact of enhanced nurse-led discharge education on patient’s perception, satisfaction and comprehension
Clinical scenario: PJW is a 67 years old male patient with a history of diabetes mellitus Type-2 who presented with a one-day history of abdominal pain and vomiting. At presentation, her temperature was 105.5F, blood pressure of 105/70, heart rate of 114 beats per minute, respiratory rate of 22 and Oxygen saturation at 98% on room air, his random blood glucose was at 25mmol/L. The patient had a mid-shaft left femur fracture eight (8)weeks prior to his presentation at the facility and had an open reduction internal fixation (ORIF) on the said limb but had been discharged from the facility with a prescription drugs that he was advised to take during his post-surgical phase. Investigation at the surgical site revealed red, swollen, warm, tender sinus that was draining purulent discharge. Additionally, PJW lives with his 18 years old grandson whom he reports seeing in two to three days.
Over the course of his management, among the most notable contributory factors to his diabetic ketoacidosis was the infection that had occurred following his ORIF. The patient had been discharged without proper nurse-led education that would have conferred enhanced patient’s perception, satisfaction and comprehension as relates to the dosages and the frequency with which both the antidiabetic and antibiotics as well as his other prescription drugs were to be consumed. Nurse-led discharge education could have also enlightened the PJW’s grandson as relates to his support to his grandfather, most so at a time when he had sustained a fracture of his mid-shaft left femur fracture. Therefore, PJW’s case prompted this study to find out evidence supporting the impact of enhanced nurse-led discharge education on patient’s perception,satisfaction and comprehension, and whether it could have conferred better outcomes in PJW’s case scenario.
Clinical question: What is the impact of the enhanced nurse-led discharge education on patient’s perception, satisfaction and comprehension?
P or Population: the patients who are provided nurse-generated enhanced discharge instructions
I or Issue: to explore impact of discharge education on patients’ experiences, satisfaction, and comprehension
C or Comparison: nil
O or Outcome: satisfaction and experiences
Search Strategy using the PRISMA flow diagram
Selection of the ‘best’ study from the table and rationale for selecting the study
Citation: Waniga H. M., Gerke T., BourgoineD., &Emaranond P. (2016). The Impact of Revised Discharge Instructions on Patient Satisfaction. Journal of Patient Experience
2016, Vol. 3(3) 64-68.RATIONAL HAS TO BE DEFINE AS PART OF THE QUESTION……
Critical appraisal of the study’s validity. interpretation and discussion of the study’s results
Study Design:Surveyin which field or department ?
Participants: The Press Ganey Hospital Inpatient Survey is availed to all adults discharged from the 180-bed facility between 2011 and 2013
Intervention:Transition record comprised of both nursing and physician education tool provided to patients upon discharge
Outcome Measures/ Results: Significant improvement of patient satisfaction scores for the overall discharge process following implementation of the revised transition record. The improvement included the extent with which patients felt ready for discharge, satisfaction with overall discharge, and satisfaction with the instructions for home care. Satisfaction rose significantly from the second to fourth quarter of the study. The discharge instructions are positively associated with improved patient satisfaction.
Interpretation/Analysis: In order to curb measurement error and variation, distribution-based methods were utilized in analysis of the data. This enhanced the specificity of the population under the survey. Similarly, an independent t test was done to determine similarity between the participants based on the questions asked that included the whether nurses kept them informed, their overall satisfaction with the physician (MD), time the MD spent with them, whether the MD kept them informed, friendliness and courtesy of both the nurses and the MD, the skills of the MD, their perception as regards the whole discharge process, speed of the discharge process, overall rating of the care given, instructions for home care and the extent the patients felt ready for discharge. Press Ganey Scores also included standardized response mean, standard deviation, P-value, and t-statistic, after which these tests were compared with the responsiveness of enhanced nurse-led discharge education on perception, satisfaction and comprehension of the patients. The level of satisfaction was significant at the end of the first quarter with more satisfaction being realized in the fourth quarter.
Discussion: Revised discharge instructions are positively correlated with improved patient satisfaction. With the obsolete discharge domain tool, patients’ rate of readiness for discharge and home care better even though the speed of discharge remained static. Revision of the discharge into the transition tool were in concordance with the findings of the study with statistical significance and improvement in discharge overall, extent with which patients felt ready for discharge, and compliance with instructions for home care. Other parameters included among the questions such as the patients’ satisfaction with the nurses and the MDs keeping them informed, were insignificant for this study. Lack of improvement in the patient satisfaction in the first quarter post-implementation of the transition tool is as a result of poor adoption of the new discharge tool with significant results being realized in the subsequent quarters progressively.
Application of the study’s results to the scenario:
From this study, standardized teaching tool aimed at improving communication at discharge enhances patient satisfaction. In this regard, tools that enhance communication between the patients and, or, with the physician as relates to the admission, the course of hospital stay including the significance of the lab tests ordered and performed as well as the significant issues surrounding patients’ follow up, have, collectively, helped enhance the patients’ understanding and perception of their quality of care. Even though the transition tool is discredited for its increased time consumed by the healthcare-providers and patients, the overall impact of the enhanced communication between the nurses and the patients minimizes on the cases of readmissions, adverse side-effects of medications, non-compliance with the long-term medications as well as limiting the potential risks of acute on chronic illnesses as was the case with PJW. Therefore, a high-quality discharge such as through the transition tool helps with quic patient recovery and healing process. From the study, the mean discharge scores by quarter as relates to discharge overall, extent felt ready for discharge, speed of discharge process and instructions at home care, were all improved with the three (3) years to 86.6%, 87.1%, 89.6% and 88.6% in the first, second, third and fourth quarter, from 82.6%, 84.5%, 86.9%, and 84.7% respectively.
LaSarso, Nicholas, “The Usefulness of Transcutaneous Electrical Nerve Stimulation for the Management of Chronic Low Back Pain”(2014). Critically Appraised Topics (CAT). 9.http://dune.une.edu/pt_studcat/9
Clinical bottom-line: ???????????????????????
ReferencesAPA 6TH PLEASE
A one-to-two-page table using the template provided that includes the references, study design, evidence level and key findings from six best studies and attached as an appendix.
|Author (Year)||Sample||Source of Evidence||Study Design||Levels of Evidence||Key Finding|
|Waniga et al. (2016)||n=21||-Medline-PubMed
-Cochrane Database of Systematic reviews
Keywords: Patient satisfaction, discharge, discharge instructions, patient education
|Hospital’s inpatient survey responses between 2011 and 2013||-Research design: Focus group-based study
-Type of the study: Qualitative study Limits used: Humans, meta-anal
|-Following the implementation of the revised discharge instructions for all patients admitted, patient satisfaction improved significantly.
|Lisby et al. (2019)||N=200||-Medline-PubMed
|Non-blinded Randomized Clinical controlled Trial||Keywords: “Impact of a comprehensive nurse-led discharge”, “acute medical unit”, “randomized control trials”||Of all the 200 participants, 22% in the intervention group had readmission cases post-discharge against 19% in the control group. Data not statistically significant|
|Glick et al. (2020)||N=192||-Medline
-Evidence-based abstraction journal
-Primary articles in journals: Perception of parent comprehension of discharge
|Prospective cohort study||-Full-text articles with keywords:
Key words “Accuracy of parent perception of comprehension of discharge”“Role of plan complexity and health literacy, comprehension of discharge instructions, prospective cohort study, less than 5 years ago
|Medication side effects were the domain with the lowest comprehension. The actual comprehension of discharge was lower than the perceived comprehension.|
|Schneider et al. (2017)||N=100||-Medline (205-2020)-EBSCO Keywords “Using technology to enhance discharge teaching” “Improved coping for patients after stroke”
|Descriptive comparative design||Focus on descriptive studies between 2015 and 2020||The group equipped with technology in enhancing discharge teaching and improved coping, exhibited higher coping.|
|Kang et al. (2018)||N=468||CINHAL (2016-2020): Keywords “discharge education delivered to general patients” “management of recovery post discharge”
|Systematic mixed studies review||The study identified four themes: quality of discharge education influences its uptake, health care professionals’ perceptions of their role in the delivery of discharge education to patients, patients’ preferences for education delivery and patients’ perception in their self-care.|
|Harrison et al. (2018)||N=43||-DARE (2016-2020): keywords “impact of unmet communication” “Education needs on neurosurgical patient”
|Qualitative exploratory analysis||Satisfied patients and caregivers generally felt well-informed and reported good understanding of their clinical care plan throughout the perioperative course while unsatisfied patients pointed out unanswered questions, unmet information needs, and confusion throughout their care.|
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