Critical Appraisal

Title and summary of clinical problem

Title

The effectiveness of nurse-led discharge education for general surgical patientsfrom

non-English-speaking background on the hospital readmission rates.

Summary of clinical problem

Nurses have a duty of care to provide effective patient communication, especially

when undertaking discharge education with patients from NESB. Effective communication is

vital to avoid harmful incidences such as post-operative wound infection, medication errors,

and unexpected readmissions (Kang, Tobiano, Chaboyer, & Gillespie, 2020). Unfortunately,

nurse-led discharge education is occasionally standardised, and this limits opportunities to

consider the needs of the patient as an individual (Karliner et al., 2013). Nurse-led discharge

education may also be delivered in a hasty manner due to factors such as time-constraints and

sub-optimal nurse-to-patient ratio (Horwitz et al., 2014; Kang et al., 2020). Discharge

education is even more complicated and time-consuming when delivered to patients from

NESB, as it will often require the services of an interpreter or translator. This places

additional pressure on already overworked nurses and any inaccuracies in the interpretation

or translation may lead to adverse patient outcomes and subsequent readmissions (Gao et al.,

2018; Kang et al., 2020).

An evidence related to personal work experience with culturally and linguistically

diverse patients in a regional hospital (emergency department and surgical unit) in a

multicultural town, several NESB patients are unable to read health-related questionnaires or

forms, and the interpreters do not complete the documents on behalf of patients. Thus, nurses

often read the questions to the patient and the interpreter interprets information or the nurse

assists the patient in completing the form with the patient’s answers as conveyed via the
interpreter; however, the accuracy of the translation might affect the quality of the discharge

education. Given this current reality, research is needed to investigate the effectiveness of

nurse-led discharge education on patient readmission, specifically for NESB patients.

Clinical question

This investigation aims to explore the association between nurse-led discharge

education and hospital readmission rate in adult patients with limited English proficiency.

The major research question is: ‘Does a nurse-led discharge education (I) for adult patients

from non-English-speaking backgrounds (P) reduce the hospital readmission rates (O)?

The target population (P) will be adult patients from NESB aged between 18 and 64

years in a large rural hospital located in a multicultural city. Patients aged under 18 years will

be excluded in this research as education may be delivered to a parent/guardian instead of the

paediatric patient directly. Patients aged 65 and over will also be excluded due to the risk of

cognitive impairment as a potential confounder. The intervention (I) will be a nurse-led

discharge education considering culturally sensitive aspects within the hospital setting in a

surgical ward as the ineffectiveness of nurse-led discharge education frequently contributes to

poor patient post-operative recovery (Kang et al., 2020). The outcome (O) will be the hospital

readmission rate.

Reproducible search strategy

The statement PRISMA was used to guide this systematic review' reporting.

Inclusion criteria  

This study included available English-language publications that reported original, primary

empirical, conceptual or roof covering published in 2013 through 2019. Conceptual,

theoretical, qualitative or quantitative studies of any research design including systematic

reviews were eligible. Studies needed to have a sub- or complete sample of patients of ethnic

minority groups or data relating to patients / consumers of ethnic minorities. Patients of an

ethnic minority broadly defined for including any group that did not speak one of the study

country's national languages, were born in another country, or those who belonged to an

ethnic minority. Outcomes related to any patient safety events were included with the

exception of the specific exclusion applied hereunder.

Exclusion criteria

Unless they were not even from countries inside the Organization for OECD, the

publications were disqualified. This omitted case studies, letters, editorials, and remarks.

Studies addressing the following were also excluded: 1) inequalities in clinical outcomes or

health results among ethnic minorities; 2) medical inequalities in mental healthcare settings

among ethnic minorities; 3) discrepancies in access to education, health prevention and

wellness promotion activities; 4) healthcare delivery disparities; and 5) safety issues or

accidents involving ethnic healthcare workers. While this study is necessary in order to

understand the health inequalities between ethnic minorities and the population, it poses its

own research line and has been deemed too large for this systematic analysis.

Table of evidence

Rationale and critical appraisal

Elements adding to the expanded danger to ethnic minority populations incorporate

financial factors, for example, salary, protection and instruction; language capability; health

proficiency; length of remain in the host nation; sentiment of estrangement and doubt for the

health expert, administrations and frameworks; and, commitment. Included examinations for

the most part contemplated these elements freely of one another with little conversation of

any connection between them. In the constrained proof accessible of this relationship, it was

obvious that LEP and health proficiency had suggestions for understanding solutions for

prescription. Health education has been investigated broadly according to poor health results

for ethnic minority patients, yet there is constrained proof in regards to its job in, and
communications with, factors connected to persistent safety events. A calculated model has

risen up out of our survey that distinguishes the main considerations that elevate the

weakness of ethnic minority patients to tolerant safety events. Further information in regards

to the aggregate effect of these components on persistent safety events is required just as

better comprehension of their relationship with one another and the degree of effect each

factor may have on potential patient safety events.

The Health frameworks change towards giving socially skilled consideration by

employing more translators or utilizing bilingual wellbeing experts were generally refered to

in the checked on articles. However studies to date have primarily investigated authoritative

and staff social fitness with regards to improving access to mind and correspondence as

opposed to forestalling risky consideration explicitly. The job of bilingual medicinal services

staff in decidedly tending to language and culture was recognized in various investigations.

Bilingual staff may improve correspondence and are profoundly esteemed by associations

and patients the same as they communicate in the patients' language and comprehend their

way of life setting. The proof from the current audit proposes that utilization of understanding

through a scope of means is significant in tending to some patient wellbeing issues however

may likewise prompts others.

Versatile advances that can decipher for understanding are perceived as a possible

answer for beat language hindrances; research shows ethnic minority buyers utilize this

innovation. Google Translate, an online apparatus, is accessible yet low interpretation

exactness of clinical phrasings has the potential for pain and mischief. Current applications,

for example, CALD-Assist (an Australian application) that utilizes pre-recorded content

words and expressions alongside pictures and recordings for united wellbeing and nursing

staff to encourage correspondence when mediators are not accessible or not handy despite the

applications have demonstrated improved fulfillment for correspondence among buyers and
wellbeing experts. More exploration is expected to comprehend the patient wellbeing

ramifications of them.

Applicability of results and bottom-line statement

This study has a few confinements. As a solitary site study at a huge urban medical place, it

may not be generalizable to little, non-showing settings, despite the fact that our outcomes are

reliable with different investigations. The study population was constrained to three

significant medical maladies, and further limited distinctly to patients who were released

home and agreed to enlist by phone, likely creation this population more practical and less

sick than an unselected gathering of patients with similar conditions. Also, this study

surveyed comprehension of diagnosis, development and meds, yet not comprehension of

caution signs or self-care. A few authors remarked on the shallow distinguishing proof of

ethnic minority patients and prescribed frameworks be reinforced to permit total ID of ethnic

minorities. There is a need to enlist more explicit socio-social information. It is perceived that

nuanced contrasts exist between different ethnic minority gatherings and assortment of

shallow pointers to recognize ethnic minority populace may not give a full image of social

and social variables molding practices and comprehension of wellbeing of a specific ethnic

minority gathering. The Australian Bureau of Statistics (ABS) prescribes that various factors

be utilized to distinguish buyers from various ethnic minorities. Wellbeing administrations

frequently just gather information identifying with language, nation and mediator use. In the

US setting, Wilson-Stronks et al. suggested level of wellbeing proficiency, social needs,

dietary needs and financial factors be gathered alongside language and religion. Additionally,

Lopez et al. suggested a computerized standard framework - planned in counsel with ethnic

minority purchasers - for gathering information concerning ethnic minority and language

capability. They considered this to be an approach to decrease the dissimilarity in quality and

wellbeing of the healthcare

 References

Chauhan, A., Walton, M., Manias, E., Walpola, R. L., Seale, H., Latanik, M., … Harrison, R.

(2020). The safety of health care for ethnic minority patients: A systematic

review. International Journal for Equity in Health, 19(1), 118. doi:10.1186/s12939-

020-01223-2

Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., …

Wollersheim, H. (2014). Improving patient discharge and reducing hospital

readmissions by using intervention mapping. BMC Health Services Research, 14,

389. doi:10.1186/1472-6963-14-389

Horwitz, L. I., Moriarty, J. P., Chen, C., Fogerty, R. L., Brewster, U. C., Kanade,

S.,… Krumholz, H. M. (2014). Quality of discharge practices and patient

understanding at an academic medical centre. JAMA Internal Medicine,173(18), 10.

doi: 10.1001/jamainternmed.2013.9318

Kang, E., Tobiano, G. A., Chaboyer, W., & Gillespie, B. M. (2020). Nurses' role in delivering

discharge education to general surgical patients: A qualitative study. Journal of

Advanced Nursing, 76(7), 1698-1707. doi:10.1111/jan.14379

Karliner, L. S., Auerbach, A., Napoles, A., Schillinger, D., Nickleach, D., & Perez-Stable, E.

J. (2013). Language barriers and understanding of hospital discharge instructions.

Medical Care, 50(4), 283-289.doi: 10.1097/MLR.0b013e318249c949

Li, J. Y. Z., Yong, T. Y., Hakendorf, P., Ben-Tovim, D. I., & Thompson, C. H. (2015).

Identifying risk factors and patterns for unplanned readmission to a general medical

service. Australian Health Review, 39, 56-62.

Lingle, C. L. (2013). Evidence Based Practice: Patient Discharge Education Barriers to

Patient Education. Retrieved from https://difitalcommons.gardner-webb.edu/nursing

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Ngai, K. M., Grudzen, C. R., Lee, R., Tong, V. Y., Richardson, L. D., & Fernandez, A.
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Appendix

Author (Year) Source of Study Design Levels of Evidence Key findings

Evidence

Chauhan, A., Internationa A systematic review of five This study is valid Ethnic minority
Walton, M., l Journal of databases (MEDLINE, because it consists consumers may
Manias, E., equity PUBMED, PsycINFO, statistical as well as experience inequity
Walpola, R. L., Health EMBASE and CINAHL) were observational in the safety of care
Seale, H., Latanik, undertaken using subject study. and be at higher risk
M., … Harrison, R. headings (MeSH) and of patient safety
() keywords to identify studies events. Health
relevant to our objectives. services and systems
Inclusion criteria were applied must consider the
independently by two individual, inter- and
researchers. A narrative intra-ethnic
synthesis was undertaken due variations in the
to heterogeneity of the study nature of safety
designs of included studies events to understand
followed by a study appraisal the where and how
process. to invest resource to
 enhance equity in
the safety of care.

Hesselink, G., BMC Intervention Mapping This study is This study provides
Zegers, M., Health framework reliable and valid. a comprehensive
Vernooij-Dassen, Services guiding framework
M., Barach, P., Research for providers and
Kalkman, C., Flink, policy-makers to
M., … improve patient
Wollersheim, H. handover from
(2014) hospital to primary
care.

Horwitz, L. I., JAMA Prospective observational Patient perceptions

Moriarty, J. P., Internal cohort study of discharge care
Chen, C., Fogerty, Medicine quality and self-
R. L., Brewster, U. rated understanding
C., Kanade, S., were high and
… Krumholz, H. written discharge
M. (2014). instructions were
generally
comprehensive
though not
consistently clear. 

Li, J. Y. Z., Yong, Australian Retrospective observational Highly valid Readmission of

T. Y., Hakendorf, Health study  evidences general medicine
P., Ben-Tovim, D. Review patients within 28
I., & Thompson, C. days is relatively
H. (2015). common and is
associated with
clinical factors and
patterns.
Identification of
these risk factors and
patterns will enable
the interventions to
reduce potentially
preventable
readmissions.