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The aim of this study is to describe the communicative strategies nurses and patients use on a micro level to ensure patient understanding during discharge discussions. The data of the study consist of 16 videotaped discharge encounters (total duration 1 h 40 mins) between nurses and patients in Finland, which were analyzed using conversation analysis. The findings reveal that patients express understanding or troubles in understanding by subtle means, such as response particles. Nurses monitor patients' reactions and adapt their subsequent actions to them, for instance by moving on to the next topic or by giving additional explanations. They also pursue expressions of understanding when needed, e.g., by prolonging the topic. This gives the patient time to react and more material to get a grip on the topic, thus facilitating displays of understanding. As a result, even if the discharge discussions consist mostly of information delivery that resembles a monological practice, the interaction is collaboratively constructed to secure patient understanding. A raised awareness of good practices already in use to secure understanding can contribute to further developing the guidelines for discharge education. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to assess how well the emergency department (ED) personnel succeed in instructing the patient at discharge., Methods: In November and December 2016 at Peijas Hospital ED, Finland, a structured questionnaire was conducted during a phone interview on patients the day after discharge., Results: A total of 132 patients interviewed. Ninety percent had received discharge instructions from the ED staff, most of them (75%) about medication. Almost half of the patients (45%) were satisfied with the communication at discharge, those not satisfied (47%) felt that the staff did not know enough of their background to give discharge instructions. Of the patients, 20% thought that they did not have the opportunity to ask questions during the guidance session, and 41% thought that the session was too short and restricted. Some patients (20%) felt that the instructions were ambiguous, but 63% (83/132) felt they were able to follow them well or very well., Conclusion: The pace of care in the ED is fast and duration of the stay is short. The patients must be able to take responsibility of their self-care. Failure to follow medical discharge instructions could lead to non-compliance. Attention should be paid to enhancing the quality of discharge instructing and the instructions provided by the ED personnel, as recurring visits and inquiry calls add to the ED workload., (Copyright © 2018 Elsevier Ltd. All rights reserved.)