Discharge Discharge is an important part of a patient’s hospital stay. Arrangements made for care at home and information relayed to patients and families can make the difference between a successful recovery and serious complications. The discharge process should begin early in the hospital stay, so that it is not left for the discharging nurse to attempt to make all arrangements and complete all discharge teaching on the day of discharge. This allows for the smoothest discharge and the most retention of material by the patient. In this chapter, you will learn: 1. How to prepare a patient for discharge 2. What information should be relayed to patients and families to ensure a successful recovery at home 3. Follow-up necessary after discharge PREPARING A PATIENT FOR DISCHARGE Discharge from the hospital can be a frightening time for patients. They have just undergone major surgery. They have been closely monitored since surgery but are now going home with no monitoring. It is not uncommon for patients to experience separation anxiety and for both patients and family members to experience difficulty dealing with minor problems. Discharge instructions after cardiac surgery are lengthy and complex. How discharge teaching is delivered makes a huge difference in retention, adherence to instructions, and anxiety at discharge. FAST FACTS in a NUTSHELL Patients and families may experience fear and separation anxiety as they are discharged from the hospital. Delivering Information Necessary for Discharge Patients only retain a small fraction of the education they receive at discharge. Several steps may be taken to improve retention. Information should be delivered in small amounts. Discharge teaching must be started early in the hospital stay, so that small amounts may be discussed at a time. (See Table 15.1 for suggestions for combining patient teaching with routine care.) The information given to patients should be in terms the patient can understand. This requires an assessment of the patient’s educational level and language abilities. Printed materials should be used along with verbal instructions, so patients and family members can reference the material later. Whenever possible, various media, such as videos, drawings, or computer programs, should be used in addition to verbal instructions and printed materials. Those who will be caring for patients at home should be involved in the educational sessions. TABLE 15.1 Suggestions for Combining Patient Teaching with Routine Care • Begin by asking the patient questions to determine knowledge level (e.g., “Can you tell me why the doctor prescribed aspirin for you?”) • Ask the patient to demonstrate specific skills (incision care, use of incentive spirometer) to determine skill level (e.g., “Show me how you were taught to wash your incisions.”) • Every time a medication is administered, review indication and side effects • Educate about taking a pulse rate and temperature while performing vital signs • Provide teaching on signs of infection while examining incisions during a physical assessment (e.g., “I am looking at your incisions for any signs of infection. What are the signs of infection? Do you see any when you look at your incisions?”) • Teach patients to perform their own incision care while bathing them • While walking a patient, talk about activity after discharge • At mealtime, educate the patient about a heart-healthy diet When teaching patients and family members, questions should be encouraged. To assess how well transfer of knowledge has occurred, the patient should be asked to repeat or demonstrate what was taught. This is known as the “teach-back” method. Asking “Do you understand?” is not an effective way to gauge understanding, because many patients will answer in the affirmative even if they do not understand. Non-English speakers and patients for whom English is not the native language are especially difficult to teach. Every effort should be made to provide translators as necessary. Family members should be engaged in the teaching process. Printed materials in the patient’s native language should be used whenever possible. 
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