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HIGHLIGHTS: The hospital selected for study the two post-discharge self care
procedures that they considered to be the simplest for a lay person to carry out:
dry dressing change and wet dressing change, to eliminate any distortion in the outcomes
due to complexity of other self care procedures such as drain evacuation, appliance changes
or catheter flushing.
The Control Group received instructions approved by the Rush-Presbyterian-St.Luke's
Patient Education Committee. They also received supplies gathered, as usual, at the
time of discharge. Given this preparation, 96% of patients were unable to carry out the
simplest self care procedure, changing a dressing, without calling back for repeat
instructions or asking for further help.
The AMA calculates that 33% of a population such as RushÕs would be functionally illiterate
in health care. That means that 63% of Rush's population is literate in health care, but
still cannot follow the hospitalÕs instructions for changing a dressing.
The Careguide group received prepackaged supplies and ethnographically-rewritten instructions.
Only 4% were unable to manage. Ninety-two percent were able to carry out their self care
independently.
By merely looking at the two types of handouts, an observer cannot perceive a difference
sufficient to account for the staggering difference in the outcomes. Ethnography and
learner-centered principles must be specifically pointed out and explained to be
appreciated, similar to sticking a label on a computer, "Intel inside."
The study was entirely designed and conducted by hospital personnel exclusively and
published in Hospital Peer Review Journal, September 2000.
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