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discharge instructions, health literacy, surgical site infection (SSI)



  1. Foertsch, Lisa Y. DNP, RN
  2. Hoffmann, Rosemary L. PhD, RN, CNL
  3. Ren, Dianxu PhD, MD
  4. Stolar, Jennifer BSN, RN
  5. Tuite, Patricia K. PhD, RN, CCNS


Purpose: The purpose of this project was to develop, implement, and evaluate a teaching tool for self-assessment of surgical incisions after laparotomy surgery.


Background: Hospitalized patients have an increased level of acuity and are discharged earlier. Shorter length of stay limits the nurses' ability to provide comprehensive discharge instructions and validate understanding of surgical incision care.


Description: Two sets of discharge instructions, 1 with text only and 1 with text and pictures plus a mirror, were provided to patients after laparotomy surgery. A total of 60 patients were recruited over a 3-month period. The first 30 patients received standard discharge instructions (text only). The next 30 patients received discharge instructions using the new program and a handheld mirror to assist with visualization of the incision. A follow-up telephone questionnaire was completed on day 7 after surgery to assess patients' ability to inspect their incision for infection and determine comprehension with discharge instructions.


Outcome: Patients receiving the revised program had improvement in comprehension of instructions, felt that instructions were clearly stated, and were confident in their ability to identify normal healing versus a surgical site infection (SSI) and about notifying physicians. Compared with the text-only group, the text, picture, and mirror group using the teaching program (text, pictures, and mirror) felt more confident on self-assessment to identify SSI.


Conclusion: The revised teaching program (text and pictures) and use of a handheld mirror improved patient confidence in self-assessing an incision and increased ease in detecting an SSI.


Implications: Clinical nurse specialists can influence patient outcomes. Discharge instructions that include text and pictures plus a mirror should be part of a comprehensive packet for patients asked to assess an incision.