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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. Pediatric Learning Guidelines

8. 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)

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

10. 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

11. 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

12. 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

13. 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)

14. 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

15. 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

16. 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

17. 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.

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

19. Answers B D