Nursing-led pediatric discharge communication and caregiver-reported counseling evaluation in Vietnam: A convergent...

Family-centered pediatric discharge care requires communication that prepares caregivers for home management, yet high-volume hospitals may compress nursing education into brief, task-focused encounters.

To examine nursing-led discharge communication, receipt of structured home-care instructions, caregiver-reported counseling evaluation, and organizational barriers in a tertiary pediatric hospital in Vietnam.

A convergent parallel mixed-methods study was conducted from January to June 2025. The quantitative strand included 196 primary family caregivers recruited consecutively; the qualitative strand comprised 11 in-depth interviews with five caregivers and six nursing staff selected purposively. Multivariable logistic regression examined receipt of structured home-care instructions. HC3-robust linear regression examined the continuous seven-item counseling evaluation score using only predictors external to that scale. Reflexive thematic analysis was used for qualitative data, and the strands were integrated through triangulation, narrative weaving, and a joint display. The dichotomized analysis is presented as an exploratory sensitivity supplement only; the primary interpretation is based on the continuous-score robust linear regression model.

All caregivers reported individual counseling, but only 36.2% reported receiving specific home-care instructions. Readmission was associated with receipt of structured instructions (adjusted odds ratio = 6.34, 95% CI [3.24, 12.39], p < 0.001). The seven-item counseling evaluation score showed very high internal consistency (Cronbach's alpha = 0.984). In the continuous-score model, printed-handout exposure correlated with a lower score (β = -0.511, 95% CI [-0.833, -0.188], p = 0.002), whereas digital-channel access was associated with a higher score (β = 0.431, 95% CI [0.006, 0.856], p = 0.047). Qualitative findings identified time pressure, fragmented responsibility, limited comprehension checking, and a gap between supportive interactions and effective discharge preparation.

Nursing-led discharge contact was nearly universal, but structured home-care instruction was inconsistent and appeared selectively prioritized. Standardized, risk-sensitive discharge education should guarantee core instructions, embed written and digital materials within interactive teaching, and verify caregiver understanding. The counseling evaluation score reflects perceived counseling quality rather than objectively verified home-care competence.