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PREPARING MATERIALS FOR PATIENTS AND FAMILIES
What should be included on the educational sheets given to patients and family members before hospital discharge? Essential information includes details about what caregivers are about to undertake (for example, if giving IM injections is required, explain that IM means intramuscular and describe what an IM injection is), definitions of medical terms, pictures of any equipment involved, and how to get questions answered. The material should be written at about a third-grade reading level to make it understandable to as many people as possible. Each paragraph should have a clear topic sentence, and details should follow (for example: “Proper use of your inhaler will help you breathe easier. Here are the reasons why…”). The material should emphasize the benefits of performing the task as directed.14
Another thing to consider when preparing family members to care for someone at home is schedules—both the patient’s and the caregiver’s. Suppose, for instance, that the patient must take a medication 4 times each day. In the hospital, routinely this could mean on a 6-12-6-12 schedule. Is this a schedule that will work at home? Most caregivers would probably say No, as this schedule allows little time for their own sleep. Will breakfast, lunch, dinner, and bedtime work instead? The answer will depend on the medication, but it might—and it is something that will need to be reviewed with the family.
Another schedule-related question involves when diuretics should be given. Most family members would probably agree that bedtime is not an appropriate time since they might be needed to assist the patient to the bathroom. If the caregiver is not made aware of this issue, however, the patient might indeed end up taking the diuretic at bedtime and having to urinate through the night.
Developing a daily calendar of things that need to be done is helpful. The calendar can include when to administer medication and when to complete tasks such as wound care or Foley care that need to be once or twice daily. Weekly or monthly calendars for events (doctors’ visits, home care nurses, physical therapy visits, medical equipment deliveries, or medication renewal calls) are also extremely helpful, especially if the caregiver is elderly. Figure 1 and Figure 2 provide examples of such calendars.
CONCLUSION
More cancer care is being delivered on an outpatient basis, and this trend will continue. These changes in health care delivery have shortened hospital stays and shifted the responsibility for much care onto family members with no medical training. In addition to accompanying the patient to doctors’ appointments and communicating with health care professionals regarding expectations for and the possible side effects of treatments, caregivers are being asked to manage equipment and schedules—complex tasks that they need to be prepared to take on.
The nine core processes that reflect the caregiving responsibility are the points that health care professionals need to make sure we address when beginning the discharge planning process with and for patients in our institutions. Education and hands-on demonstrations whenever possible are essential pieces of the overall health care continuum that begins with entry into the hospital system and ends when the patient no longer requires services. This continuum covers diagnosis through survivorship and/or death, with special emphasis on the needs of the caregiver throughout the process. Additional resources, whether online, in print, or available by phone contact, are important pieces of the overall care planning that needs to occur if cancer patients are to return home and remain safe in that environment. ONA
Ro Tucci is the manager for oncology research and data services at Lankenau Hospital, Wynnewood, Pennsylvania, and a member of the Oncology Nurse Advisor editorial board.
REFERENCES
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10. Caregiving for your loved one with cancer. CancerCare Connect. 2008. http://www.cancercare.org/pdf/booklets/ccc_caregiver.pdf. Accessed June 10, 2010.
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14. How to write easy-to-read health materials. MedlinePlus. http://www.nlm.nih.gov/medlineplus/etr.html. Updated August 21, 2009. Accessed June 10, 2010.
