Securing patient understanding in nurse-patient discharge discussions

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.