This detailed summary introduces the research article titled “The acquisition and effectiveness of “IDEAL” standards in discharge planning and education with simulation method” by Keçeci, Demiray, Kızıltepe, İlaslan, Açıl, and Ertürk. Published in BMC Nursing in 2025 (Volume 24, Issue 856), the article investigates a crucial area of nursing education and patient safety.
While patient and family education is a shared responsibility among healthcare team members, discharge planning to impart self-care skills is primarily the nurse’s responsibility. Unfortunately, patient satisfaction with current discharge education is often suboptimal. Inadequate education regarding disease management and medication use is a significant factor contributing to avoidable hospital readmissions and threatening patient safety. Current literature indicates that nursing students frequently lack sufficient opportunities to practice comprehensive discharge planning in clinical settings, and there is a gap in studies exploring the structured integration of the IDEAL discharge planning framework into nursing education through simulation.
This study aimed to address these deficiencies by examining the improvement of nursing students’ discharge education competencies through a simulation method aligned with the IDEAL discharge planning model. The IDEAL model, developed by the Agency for Healthcare Research and Quality (AHRQ), emphasizes five key components for patient-centered discharge planning: Include the patient and family, Discuss essential areas to prevent complications, Educate throughout the hospital stay using clear language, Assess understanding, and Listen to goals, concerns, and preferences. The study sought to increase students’ competencies in complex and continuous discharge planning and education by applying these strategies through simulation.
The researchers employed a mixed-method design, specifically a convergent-parallel approach, collecting and analyzing quantitative and qualitative data simultaneously.
- Participants: The study included nineteen second-year nursing students enrolled in surgical nursing courses during the 2023–2024 academic year. These students were chosen because they had completed foundational nursing courses, were concurrently in surgical nursing, and were beginning their active clinical practice.
- Intervention: Participants engaged in a five-session simulation, with each session lasting approximately one hour. These scenarios were meticulously structured around the IDEAL discharge framework, guiding students to practice patient-centered communication and discharge planning, including involving families, discussing risks, providing clear education, assessing understanding, and responding to feedback.
- Data Collection Tools:
- Quantitative data was gathered using the General Self-Efficacy Scale (pre- and post-test) and the Simulation Design Scale.
- Qualitative data was obtained through semi-structured individual in-depth interviews.
- Data Analysis: Quantitative data was analyzed using mean, standard deviation, and paired t-tests, while qualitative data was analyzed using descriptive content analysis.
Key Findings: The study yielded important insights into the effectiveness of the simulation intervention:
- Quantitative Results:
- Post-test scores for discharge education sessions increased across the board compared to pre-test scores, indicating overall improvement.
- The most significant improvement was observed in the “continuation effort and persistence” sub-dimension of the General Self-Efficacy Scale during the fourth session. This particular session focused on medication education, an area where qualitative data revealed students initially felt less confident due to a lack of knowledge. The increased scores in this sub-dimension suggest students recognized the importance of medication education and exerted greater effort in this area.
- Regarding the Simulation Design Scale, the “support” sub-dimension received the lowest mean score (4.24 ± 0.56), while the “degree of fidelity (realism)” received the highest (4.58 ± 0.52). The lower “support” score may be attributed to students’ unfamiliarity with the application and their expectation of more support from educators.
- Qualitative Results:
- As simulation sessions progressed, students consistently reported greater confidence and improved communication skills.
- Despite these improvements, challenges persisted in applying some IDEAL components, particularly in discussing patient goals and actively involving families in the discharge process. Students also desired to change aspects such as better communication, planned behavior, obtaining more information, and utilizing educational materials more effectively.
- Students emphasized the importance of holistic patient evaluation, empathic approaches, managing personal stress, and ensuring sufficient preliminary theoretical knowledge for effective discharge education.
The study concluded that the simulation intervention effectively improved nursing students’ discharge education skills and significantly increased their self-confidence. The integration of the IDEAL framework proved instrumental in fostering more patient-centered care by emphasizing the active inclusion of patients and their families in discharge planning. The findings underscore the effectiveness of simulation in reinforcing communication, planning, and patient education competencies in future healthcare professionals.
The study acknowledges several limitations, including the exclusion of quantitative data from three students due to internet problems, potentially limited internalization of experiences due to short time intervals between some sessions, and the qualitative data being confined to student perspectives without patient input. Furthermore, the small sample size and single-institution design may limit the generalizability of the findings to other nursing programs.
Reference: Keçeci, A., Demiray, A., Kızıltepe, S. K., İlaslan, N., Açıl, A., & Ertürk, F. (2025). The acquisition and effectiveness of “IDEAL” standards in discharge planning and education with simulation method. BMC Nursing, 24(856). https://doi.org/10.1186/s12912-025-03394-1
