Discharge Teaching Presented by: Danyel Dorn RN, MSN, CPN, Clinical Nurse Educator-Pediatric Service Line

Purpose People are lifelong learners. The perianesthesia registered nurse will be able to recognize the learning process and be able to provide discharge instructions to the pediatric perianesthesia patient and his or her family/adult caregiver.

Competency Statement The perianesthesia registered nurse will demonstrate clinical skills in providing post procedural and Postanesthesia education to the pediatric patient and his or her family/adult caregiver.

Domains of Learning Cognitive Domain Affective Domain Learner develops intellectual skills Learner needs further knowledge Affective Domain Learner develops emotional attitudes and values Learner needs a change in attitude Psychomotor Domain Learner develops motor or physical skills Learner needs to acquire a skill

Expected Outcomes of Education Ensure continuity of care Comply with treatment plans Alleviate fear and anxiety Identify coping skills Prevent or reduce complications Manage pain Enhance family/adult caregiver support Assist in return to activities of daily living/independence

Barriers to Learning Age Physical/developmental disabilities Intellectual ability Literacy skills Foreign language Motivation/willingness to learn Pain Anxiety/stress Cultural beliefs Religious beliefs Limited time

Pediatric Learning Guidelines

Learning Styles Visual learners takes in information through the eyes Learn by observing or reading Auditory learners take in information through the ears Remember things heard Tactile learner takes in information through the sense of touch Need to feel texture and shapes Kinesthetic learners take in information through the muscles Need to move in order to process new information (talk with hands; move side to side when talking, manipulate objects, do the task involved with hands-on skills)

Teaching Methods Discussion Individual teaching and group teaching Demonstration and patient/caregiver return demonstration Role playing Interactive (computer programs)

Teaching Tools Written Audio Visual Books, pamphlets, coloring books, handouts (specific for type of surgery or from surgeon) Audio CDs, iPODs, cassettes, tapes Visual Pictures, books, charts, models, computer interactive programs, play therapy, puppets

Develop/Continue Discharge Teaching Discharge teaching should begin before the patient’s admission Assess and identify the physical and emotional needs of the patient Identify the learning needs of the patient and adult caregiver Recognize the learning style of the patient and adult caregiver Discuss and determine quality outcomes with the patient and adult caregiver

Develop/Continue Discharge Teaching Individualize discharge teaching to the patient’s specific procedure Assure the environment is conducive to learning; minimize distractions Use simple terms; avoid medical terminology Explain the benefits of medical interventions Present teaching instructions in organized steps and parts Identify the learning tools that will be used in discharge teaching Provide preprinted or written teaching sheets as a home resource

Provide Discharge Teaching Instructions should be specific to the pediatric patient’s age, procedure and medications administered. The nurse educator must determine what needs to be known by the patient and adult caregiver. Potential topics include but are not limited to: Hydration and diet (explaining to parents to be aware of wet diapers and not to worry about solid foods as much as fluid intake and hydration)

Provide Discharge Teaching Safety Explain about keeping medications away from children. Instruct caregivers not to tell them its “candy” so they will take it; do not mix medications in bottles or drinks, parents will not know if the child took the appropriate dose Hygiene Elimination Catheter care and ostomy care Wound care and drain care Ambulation Activities and restrictions Positioning Local and regional anesthetic blocks for pain control

Provide Discharge Teaching Pain management: pharmacological and non-pharmacological interventions Surgical complications: signs and symptoms Medical devices and equipment General and specific instructions from surgeon, proceduralist, anesthesia provider and the facility’s protocols Discharge prescriptions: purpose, dose, frequency and side effects Postoperative office/clinic appointment Community resources/referrals: home healthcare, support groups, physical therapy, occupational therapy, behavioral therapy, and county/federal health agency programs

Evaluation of Discharge Teaching Effectiveness is measured by learner’s increase in knowledge, change in behavior and/or attitude and development of clinical skills. The pediatric patient and adult caregiver’s understanding of teaching outcomes can be determined through: Observation Interview: use of open-ended questions Dialogue Return demonstration Checklist

Document Discharge Teaching Record the patient and adult caregiver’s understanding of discharge instructions in the medical chart. Keep copies of signed teaching sheets in the medical record also. This documentation allows other healthcare staff to know the specific topics taught, the teaching methods used and the patient and adult caregiver’s response to teaching. Joint Commission requires documentation of patient and adult caregiver’s education. There can be legal and financial ramifications for the healthcare facility if documentation is not done.

Reference ASPAN (2016). A Competency Based Orientation and Credentialing Program for the Registered Nurse Caring for the Pediatric Patient in the Perianesthesia Setting.

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