Concept Analysis of Discharge Instructions - Research Paper Example

? Concept Analysis of Discharge Instructions Introduction The process of patients discharge from health care facilities is quite complex. This process involves medical practitioners like the physicians, nurses, therapists, and care coordinators (Smith, Fields, & Fernandez, 2010). The discharge process begins once one is admitted and continues throughout his/her stay in the hospital. Upon discharge, the patient or their surrogate is issued with written instructions by the respective medical practitioner. In addition, the practitioner explains in details the contents of the discharge instructions. These instructions provide patients with critical information on how to manage themselves in terms of medication, diet and which symptoms should prompt the patient to return back (Lee & Bokovoy, 2005). Issuing of discharge instructions to patients is a key requirement of health care facilities by the health accreditation institutions such as the Joint Commission on Accreditation of Healthcare Organizations-JCAHO (JCAHO, 2007). Despite holding to this requirement, it is widely reported that patients fail to comprehend or remember the discharge instructions. This is contributed by both parties: practitioners failing to elaborate clearly the instructions and patients failing to follow the instructions. This paper is a concept of comprehension that focuses on discharge instructions and how patient’s comprehension of these instructions affects their outcome. Concept of Comprehension on Discharge Instructions Discharge instructions refer to instructions given to patients upon discharge from hospital. These instructions detail diagnostic information and measures to be taken. As noted by Forster et al. (2004) close to a quarter of patients discharged experienced adverse cases in a span of one month. These events were medication errors, orders/prescriptions filling, confusing discharge instructions, neglect of following unresolved cases and infections. Some of these effects were preventable whereas others called for further treatment probably half of the effects. Moreover, Forster et al asserted that a third of the events were linked with disability (Forster et al., 2004). According to Zavala et al. (2011) 78 percent of discharged patients from emergency department failed to fully comprehend the discharge instructions. However, 20 percent acknowledged they did not understand the discharge instructions. This was achieved from a study conducted in a healthcare facility in Virginia, Reston Hospital Center. This study focused to reach the discharged patients from the facility in order to get their understanding of discharge instructions and its effect. A fifth of the patients interviewed did not understand the discharge instructions based on the medicine described. Additional 9 patients reported worsened and continued symptoms where they were reminded to follow up treatment. A few patients reported their discomfort about the discharge instructions and some did not receive the discharge instructions (Zavala et al., 2011). Understanding as well as memorizing discharge instructions is very challenging. This is associated with several aspects such as discomfort and literacy levels. Relative to discomfort, patients and their surrogates are filled with various discomforts emotionally and physically. More specifically, patients and their surrogates are filled with excitement of leaving hospital. This carries away their attention and thus they are less concerned about the discharge instructions. Additionally, the busy hospital environment during discharge also causes discomfort to the patient/patient surrogates and distracts their attention to discharge instruction. In such a situation, the busy physicians assume patients understand the instructions and to further complement this health brochures are given. Majority of patients obtain and understand little of these information from the health brochures. This creates great disparity between the reading and literacy levels of the patients. In regards to literacy levels, majority of patients and their surrogates lack the relevant knowledge pertaining to medical terminology. The terminology used by medical practitioners creates a barrier in communicationbetween them and patients particularly the illiterate in health issues. Medical practitioners use facile medical terminologies which results to a miscommunication and confusion between the two parties. Lackingof comprehension about the medical terminologies coupled with limited healthknowledge and ability to integratedischarge instructionslimit patients’ communication skills with health practitioners.Multiple studies have shown that use of medical terminologies by practitioner’s results to inadequate as well asconfusing communication. According to Mayeaux et al. (1996) patients expressed that physicians did not explain adequately about their illness, treatment as well as measures to follow for home care. Another study showed that patients forgot almost half of the instructions given shortly after leaving the health care facility (Forster, Murff, Peterson,Gandhi & Bates, 2003). In addition, families’ inability to take care of patients at home and shortage of outpatient/homecare facilities affect comprehension of discharge instructions. Furthermore, patient’s ignorance I also affect in some way. Patients either knowingly or not stop medication and other treatment after feeling better. This has adverse effects that are more emphasized to the illiterate. This is because they do not have the knowledge of the symptoms and how to approach the situation if it worsens. Poor or limited literacy in the matters relating to health is widely associated with elderly and underprivileged patients. For this reason, they face complication in communication and understanding discharge instructions about medical conditions like diagnosis, and medication. Lack of good communication discourages from asking questions where they do not understand the discharge instructions. Ultimately, this contributes to them reporting worse health conditions and increased hospitalization and readmission rates. In turn, this translates to higher costs of treatment and medication. Effects of Patient Understanding of Discharge Instructions Satisfaction and Comfort Understanding of discharge instructions have been seen to have an effect on the patient satisfaction and comfort. In return, this has influence on the outcome of treatment offered to the patient. This is supported byJCAHO study on the effect of comprehensive discharge instructions conducted on patients with heart failure. From this study, patients with full aware (satisfied) of the discharge instructions had reduced likelihood of readmission to the hospital for any cause even heart failure unlike their counterparts (VanSuch, Naessens, Stroebel, Huddleston, and Williams, 2006). This shows that there was major improvement on the health of the patients with heart failure. On the contrary, the reverse is true. That is, those patients who were less satisfied and comfortable with the discharge instruction experienced persistent worsened health conditions which prompted high likelihood of readmission (VanSuch, Naessens, Stroebel, Huddleston, and Williams, 2006). Patient Compliance The understanding of discharge instructions influences patient’s compliance to medication and overall treatment. Indeed, this in turn influences the outcome of the treatment. For instance, earlier, the discharge instructions for patients diagnosed with asthma required them to take theophylline as well as comply with the follow up treatment. This is contrary to today where patients are required to use peak flow meters, inhalers, therapies, oral medication and control environment triggers to control and monitor the disease (Williams, Baker, Honig, Lee, and Nowlan, 1998a). The complexity of recent medical technology hinders patients from understanding clearly the discharge instructions. Nonetheless, patients are expected to follow properly these instructions. Additionally medical practitioners also face difficulties with the modern medical technologies. In return, this hinders them from explaining fully and clearly the discharge instructions to the patients. For this reason, limited literacy is seen as a hindrance on both sides. In respect to patients or patients’ surrogates, limited literacy causes poor compliance to the discharge instructions. This is because of little knowledge and understanding of the diseases. Moreover, the patients lack the essence of following up treatments. As a result the patients fail to stick to the recommended dosage thus causing severe medication side effects. This is more pronounced for patients having chronic diseases such as asthma, hypertension, diabetes and so forth (Williams, Baker, Parker, and Nurss, 1998b). Conclusion The comprehension of discharge instructions by patients is very essential in health care. It enables patients to monitor their healthcare at home. This is achieved through enhancing patient’s satisfaction/comfort and compliance to the discharge instructions. However, this has not been the case with this process. This has been attributed to various significant factors such as poor literacy levels and discomfort. Illiteracy levels influence highly how patients understand discharge instructions. They influence communication, reading as well as the understanding of the patients. This is further worsened by wide usage medical terminologies which confuse even the elites. This triggers poor satisfaction and compliance to discharge instructions. As a result this worsens the health conditions of patients leading to increased readmissions hence high health cost. Therefore, understanding of discharge instructions is important and should be highly encouraged (Boughton & Halliday, 2009). References Boughton, M., & Halliday, L. (2009). Home alone: Patient and carer uncertainty surrounding discharge with continuing clinical care needs. Contemporary Nurse, 33 (1), 30-40. Forster, A. J., Clark, H. D., Menard, A., Dupuis, N., Chernish, R., & Chandok, N. et al. (2004). Adverse events among medical patients after discharge from hospital. Canadian Medical Association Journal, 170 (3), 345-349. Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med, 138 (3), 161-167. Joint Commission On Accreditation Of Healthcare Organizations (JCAHO). (2007). JCI Accreditation Standards For Hospitals. Third Edition. Lee, T., & Bokovoy, J. (2005). Understanding discharge instructions after vascular surgery: An observational study. Journal of Vascular Nursing, 23 (1), 25-29. Mayeaux, E. J. Jr, Murphy, P. W., Arnold, C., Davis, T. C., Jackson, R. H., and Sentell, T. (1996). Improving patient education for patients with low literacy skills. American Family Physician, 53, 205–211. Smith, B., Fields, C., & Fernandez, N. (2010). Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Physical Therapy, 90 (5), 693-703. VanSuch, M., Naessens, J. M., Stroebel, R. J., Huddleston, J. M., and Williams, A. R. (2006). Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care? Quality & Safety In Health Care, 15 (6), 414–7. Williams, M.V., Baker, D. W., Honig, E. G., Lee, T. M., and Nowlan, A. (1998a) Inadequateliteracy is a barrier to asthma knowledge and self-care. Chest, 114, 1005–1015. Williams, M. V., Baker, D. W., Parker, R. M., and Nurss, J. R. (1998b). Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine, 158, 166–172. Zavala, S. et al. (2011). Do patients understand discharge instructions? Journal of Emergence Nursing, 37 (2), 138. Read More