initiating patient teaching

nurseprnRN, BSN, RN · Mar 24, 2015

Discharge planning (and teaching) really does begin the day of admission, and continues at every interaction you have. It's expected of you in your role as a nurse. You wouldn't expect it of somebody you met at the store, but a patient does expect it of you in the care relationship. Nothing to be shy about.

"What has your primary care told you about X?"

"Before you go home, we'll be telling you how to ..."

"Do you remember when we met we discussed ...? Let's follow up on that before you have your test this afternoon."

"This is (drug x). It's for ... and works by ... . Have you taken it before? How did that work out for you?"

"I notice you're walking pretty well now. How many steps do you have to climb at home?"

and so forth

If you can, put yourself in the patient's shoes. What do you wish your nurses would tell you?

Jenngirl34RN · Mar 25, 2015

Start by incorporating little things, like making sure the patient remembers to use their call light or PCA button, into every interaction. Asking the patient if they have any questions you can answer is good too. Start making that part of your routine, and build up from there.

ixchel · Mar 25, 2015

Oh, man, every time I walk in the room I have something for them, even if it's something small. Some ideas:

(1) meds: you said you don't talk to them about their meds. Understanding meds is actually something that is surveyed for patient satisfaction scores. If you have a hard time multitasking, get through your 5 Rs, or however many Rs your program has you going through, and then as you hand that med cup over (after you've gotten through knowing you didn't mess up), tell them every single med you're giving them, what each med does in a brief way ("this is metoprolol, your blood pressure medication."), and then ask if they have questions about any of them. Always have a pocket med guide on you for this. Usually, they don't have many questions. But look! Bam! Patient education complete!

(2) Are any of their meds new, with the expectation that they'll keep taking it after discharge? Tell them this. Tell them frequent side effects, and reassure them that if they have unbearable side effects, they need to call their PCP, but never stop just taking the medication without having a plan to change meds in place.

(3) Plan of care. Do they have tests happening that day? Help them understand what to expect during each procedure if they've never had it before. For example, MRIs are small and noisy to the point that some people are claustrophobic. Assess the patient's need for sedatives while you talk to them about this.

(4) If a patient has no testing that day, what are their goals for discharge? Talk about those goals. Assess for knowledge deficits, and fill in the gaps.

(5) Assess for habits that might be negatively affecting their condition. For example, a person with AKI and a history of hypertension needs a good talking to about medication compliance, diet, and staying the course even when they feel well. HTN is the silent killer!

(6) Discharge planning - do they know what they need to transition back home? If they have a decrease in functionality, what kinds of changes need to happen for them to take care of themselves? Are there community resources that can help?

(7) How about ADLs? Could they struggle with them somehow? Can you help them with that? An example - I had a post op GI surgery patient in ICU that I could tell was extremely nervous to do absolutely ANYTHING that required core muscles. Some of the scariest things are sneezing, coughing and pooping. I made sure to tell my patient that a pillow held with gentle pressure across the abdomen will help those things feel less scary, more controlled.

And if all else fails, just ask the patient what they want to know. "You've had a busy few days and you've probably been hit with a lot of information all at once. Do you have any questions I might be able to answer for you? It's possible I won't have all the answers, but if that happens, I'm happy to look up anything I can for you."

pixiestudent2 · Mar 26, 2015

Thanks so much, this was exactly the kind of advice I was looking for!!