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ANA code of ethics:

Provision 1 -- nurse's primary commitment is to the patient (Winland-Brown, Lachman, & Swanson, 2015)

Provision 2 -- we must advocate for and protect the rights, healthy and safety of the patient (Winland-Brown, Lachman, & Swanson, 2015)

Providing adequate discharge teaching is part of a nurse's commitment to the patient.

Nurses must advocate for the right of the patient to be adequately informed of their condition and treatment plan for their safety.

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Uploaded by Jermaine Marcella on 2017-04-29.

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87% of patients who come to the Emergency Department (ED) are discharged back to their residence (Atzema et al., 2013).

Patients who are discharged to home have only their discharge instructions to help them manage their health at home.

The fast-paced and, often, overcrowded environment of the ED creates challenges for nurses to deliver adequate discharge instructions.

Inadequate discharge teaching leads to "worse health outcomes, including increased ED visits" and hospitalizations (Samuels-Kalow et al., 2015).

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Uploaded by Jermaine Marcella on 2017-04-29.

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NUR 315 taught me two fundamental concepts that I can apply to this issue:

1. Nurses are trained not only to act and think but also to educate.

2. Nurses have a legal and ethical responsibility to protect their patient's privacy.

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1. Inservice or further training: ED nurses should be reminded of the importance of discharge teaching and the proper way to discharge a patient

2. Build a team: a team of nurses should be set to handle this particular issue.  This team could assess nursing compliance on discharge education and address problems that may arise.

Helps the nurses take a more proactive approach in solving this issue

3. Provide incentives: nurses who provide thorough discharge instructions as evidenced by their documentation or patient-survey should be recognized

Shows that the whole unit supports the nurse's effort to provide thorough discharge education

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Challenges or barriers for nurse involvement:

Environment -- ED nurses are sometimes forced to perform discharge teaching in hallways or internal waiting rooms

Added task at finding a suitable place

Limited staffing -- nurses are not able to provide the adequate time needed

Increased staffing, may result in increased the financial burden within the unit

The Centers for Medicare and Medicaid Services support "compliance measures" for discharge instructions of admitted patients but does not specifically address ED discharge (Atzema et al., 2013, p. 2)

If the nurse is not participating, or the participation is limited, explain why.

Sensitization -- nurses no longer see the importance and value in discharge education

Literature focused on increased provider participation and use of technology to amend nursing participation

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Explain why the nurse’s involvement is important:

Nurses are the last healthcare team member the patient sees in the ED. They provide the patient with their discharge papers and instructions.

How would the nurse be able to help resolve or improve the selected issue?

Provide "protected time" -- ED nurses could set aside uninterrupted time in a quiet, distraction-free environment in order to optimize patient learning (Samuels-Kalow et al., 2015, p. 285)

Perform follow-up telephone calls or emails -- allow nurses opportunity to clarify discharge instructions

Increase compliance with discharge instructions and adherence to follow-up appointments (Boonyasi et al., 2014)

Perform teach-back: nurses are able to assess patient comprehension

Teach-back also helps in retention of information (Griffrey et al., 2015)

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What is the nurse doing or not doing in relation to the issue?

To maximize the number patients seen in the ED, discharge instructions may be “truncated” or “delivered in as little as 2 minutes and often without assessing patient comprehension” (Limpahan, Baier, Gravenstein, Liebman, & Gardner, 2013, p. 1300)

Exacerbates the problem by providing inadequate discharge teaching

Indicates the need for more training in providing proper discharge teaching

Printed "diagnosis-specific discharge instructions" (Boonyasi et al., 2014) -- gives nurses guidelines for discharge teaching and patients a reference

Inconsistently reinforced with verbal instructions

New ED patient flow system -- increase efficiency in the ED

Require more nursing staff -- without enough staff, there is more pressure on the nurses to quickly discharge patients

Internal waiting rooms -- not optimal for delivering discharge education (Marino, Mays, & Thompson, 2015)

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Discharge Teaching in the Emergency Department

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Discharge Teaching in the Emergency Department

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By Jermaine Marcella