5 Steps to Teaching Effective Hospital Discharge

• Discharge teaching should be tailored to each patient’s individual learning style(s). 
• Nurses should assess patients’ readiness to learn and address any barriers to learning.  
• Provide general teaching to cover all aspects of patients’ care and diagnoses.

Your lunch break is coming in 15 minutes. The charge nurse has been asking you to discharge your patient for a while. You rush to print the discharge packet, give quick instructions, and ask the patient to sign.  

Whew! Just in time for lunch. Now imagine, two weeks later, you see the same patient readmitted to the hospital with worsening symptoms.  

Although there are various reasons why a patient may return to the hospital with the same or worsening symptoms, a lack of teaching about hospital discharge can play a role. According to a 2021 study in the American Journal of Nursing, patients are less likely to be re-hospitalized when they are assisted in understanding their diagnoses, medications, and treatment plans.  

Effective teaching is more than giving instructions. Assessment, preparation, and communication all play a role.  

While teaching patients from a standard discharge sheet may be easy, there may be better ways to ensure effective learning. Learning should be tailored to each patient’s learning style and ensure that patients and everyone participating in the care at home are present and ready to learn.  

Assess Learning Styles 

To effectively teach about hospital discharge, inquire if the patient knows their own learning style. If so, make an effort to tailor teaching appropriately. If the patient is unaware of their learning style, you can help them uncover this information by understanding these four learning styles according to the V.A.R.K. model.

Visual

These learners prefer to learn by visualizing the material in graphics. If the discharge paperwork includes diagrams, charts, graphs, arrows, and other shapes, emphasize these during the teaching session.

Aural/Auditory

These learners prefer to learn by listening to the material. A patient with this learning style may prefer to listen to you speak the instructions. You can also refer them to online educational videos or audio recordings (as appropriate per your facility’s protocol).

Reading/Writing

These learners prefer to learn by seeing information displayed as words. Before starting discharge teaching, allow a patient with this learning style some time to read the discharge paperwork beforehand.

Kinesthetic

These learners prefer to learn through demonstration or simulation. Patients with this learning style would benefit greatly from practicing skills.

Once you have helped the patient discover where they fit, adjust discharge teaching to accommodate the appropriate learning style to the best of your ability (as per facility protocol). Keep in mind that some patients may have more than one learning style.

Assess Readiness to Learn 

Assessing the patient’s readiness for learning involves making sure that there are no personal barriers in place. Barriers can include sensory deficits or emotions like frustration or confusion. Here are three assessments nurses can make to ensure that patients are comfortable and ready to learn. 

Is the Patient Agreeable with the Discharge Plan? 

Make sure the patient feels ready to be discharged. Ideally, the patient should be in agreement with the hospital discharge plan prior to initiating discharge teaching.  

If not, inform the physician or discharge planner (or follow the appropriate chain of command at your facility). Once the patient is agreeable, ensure that they are comfortable enough to receive the teaching. 

In some cases, you may have to teach when the patient is not entirely agreeable – for example, when patients want to leave the facility against medical advice. 

Does the Patient Have Pain or Discomfort? 

Before teaching, make sure that pain medications have been administered and other comfort measures have been taken as needed. Consider peak times for medicines so the patient is alert enough for teaching.  

Be sure that the patient is in a comfortable position. For example, if the patient just had surgery on their arm, ensure that the affected arm is in a comfortable position.

Does the Patient Use Assistive Devices? 

When teaching, it can be easy to forget the simple things that can make a big difference. The patient should be able to see and hear you clearly.

They should be able to read the discharge paperwork without any difficulty. Ensure that the patient is wearing visual and auditory assistive devices if needed (like prescription/reading glasses or hearing aids). 

Prepare the Learning Environment 

Preparing the environment means making sure there are no environmental and social barriers to learning. These may include involving family/caregivers in the teaching session and scanning the environment for comfort barriers.

Here are three environmental assessments nurses can make to ensure that patients and families/caregivers are prepared to learn.

Are family/caregivers available for learning?

It is essential that all individuals involved in the patient’s at-home care are present during the teaching session. This includes family members or caregivers who can participate either in person or via virtual or telephonic sessions.

If you are demonstrating a particular skill, the person helping the patient with the skill should be present and able to participate in the demonstration, if applicable. Family/caregivers can be current in person or through virtual/telephonic sessions.

Are medical supplies available and at the bedside?

If teaching a skill, ensure all medical supplies and/or equipment needed for the skill are at the bedside. For example, if leading a family member to dress a patient’s wound, ensure that all dressing supplies are readily available at the bedside before teaching.

This way, there are minimal interruptions during the teaching session.

Has the physical environment been prepared?

Something as simple as proper lighting and a reduced noise level can make a significant difference. You may close the door to reduce noise and ensure privacy.

If the patient has a shared room, make every effort to provide the teaching in as private a way as possible. For example, draw curtains and write down sensitive words instead of speaking to them loudly if the patient is uncomfortable.

Collaborate with the Discharge Planner or Case Manager 

Many hospitals employ case managers and discharge planners to help smooth the discharge process. Collaboration with the discharge team is essential, as home-care needs might need to be identified and addressed before the patient returns home.

Case managers and discharge planners are skilled at ensuring that all home care needs are identified, anticipated, and met. Once this information has been confirmed, the nurse is better prepared to teach.  

Assessment Questions the Nurse Can Ask Prior to Hospital Discharge

• Will the patient have any home care service (e.g., home health, hospice, safety evaluation)? 
• Does the patient have a post-discharge follow-up health provider appointment? 
• Will the patient have any referrals to specialists (e.g., physical therapist, dietician, surgeon)? 
• Does the patient need any medical equipment or supplies for home use (e.g., wound dressing supplies, mobility device, special bed/mattress)? 
• Are there any special medications that need to be given at home (e.g., new injections, IV therapy, ointments)? 
• Will the patient stay with a family member after hospital discharge? 

Provide General Teaching  

Discharge teaching does not always focus entirely on the primary diagnosis given to the patient upon admission. Teaching may also include care tips for other conditions that were being managed while hospitalized. When teaching, nurses should also include these conditions (per facility protocol).

For example, a patient may have been admitted for pneumonia, but the physician also managed their diabetes and high blood pressure during the stay. In this case, nurses are encouraged to educate the patient on all three conditions and focus on specific needs related to each one.  

Let’s say the patient’s diabetes medication changed during their stay and will be ordered as a home dose. Although pneumonia is the primary diagnosis, the nurse should educate the patient on the new diabetes medication.  

Some hospitals may include discharge instructions for general preventative care measures like childhood vaccines or other age-related recommendations (e.g., routine colonoscopy). The goal is to help the patient avoid returning to the hospital for any problem. 

The Bottom Line

Nurses are instrumental in keeping patients out of the hospital and safe at home. Although you may feel rushed to discharge patients, manage your time by preparing for discharges the moment you start your shift.  

Start the process early if you arrive at work and find out your patient will be discharged that day. Ask the patient about their learning style during their initial assessment.  

Early on, please plan to include the family in teaching if needed. Set up a shift if you need to teach a skill at discharge.  

Lastly, communicate with the discharge team as often as necessary throughout your shift to ensure a safe hospital discharge.  

Read More