dissertationHospital discharge instructions are critical for a patient's posthospitalization recovery. When patients are discharged to home they frequently have to manage wound/incision care, change dressings, take medications, modify activities, follow specialized diets and recognize signs or symptoms that require medical attention. Unfortunately, conditions of hospitalization, effects of illness on cognition, and low health literacy impact a patient's ability to understand discharge instructions. Two studies were completed for this dissertation research. The first was conducted to understand how discharge instructions are created and used by healthcare professionals and by patients. Semistructured interviews were conducted with 5 nurses and 5 doctors who work at the University of Utah Hospital Cardiovascular Medical Unit and 5 patients recently hospitalized on this unit. Coded interview segments were analyzed to reveal themes, which converged with discharge instruction literature, that were then developed as strategies to improve discharge instructions. Strategies included the modification of content through text simplification to improve patient comprehension, the enhancement of readability with logical formatting, the use of discharge instructions to provide consistent information to the patient and the inclusion of pictures or illustrations. The second study was a randomized controlled trial with aims to evaluate the effect of standard versus pictograph-enhanced discharge instructions on immediate and delayed patient recall of the content of and patient satisfaction with their discharge instructions. Participants were randomly assigned to receive standard (n = 71) or pictograph-enhanced (n = 73) discharge instructions and were asked to recall the content of their instructions at discharge and 1 week post discharge. Patients who received pictograph-enhanced discharge instructions recalled more of their instructions at discharge than those who received standard discharge instructions, (t(142) = -3.1, p < .01), and were also more satisfied with the ease of understanding discharge instructions one week after hospital discharge than those who received standard discharge instructions (z(142) = -2.4, p = .016). A multifaceted, comprehensive approach is essential to assist patients through the transition from hospital to self-care. The results of these studies, to improve discharge instruction creation and enhance their understandability, provide interventions that can serve an important role in such an approach
