Transcript Admission, Discharge & Patient`s Rights

N-205 Fundamentals of Nursing Lecture
 Understand
the importance of the
communicator, while providing continuity of care
of client in developmental crisis.
 Establish an effective role as communicator to
enhance the nurse-client relationship.
 Keep client, family, and all health care providers
informed of transfers within facilities.
 Discuss the nurse’s responsibility of clients
leaving the agency against medical advice
(AMA).
 Understand
what discharge planning is and its
guidelines.
 Understand the importance of teaching self-care
topics to clients and families for the continuity of
care.
 Hospitals
 Primary
Care Centers
 Ambulatory Care Centers
 Home Healthcare
 Long-term Care Facilities
 Specialized Care Centers
 Inpatient
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and Outpatient Care
Inpatient – a person who enters a healthcare facility
and remains for more than 24 hours
Outpatient – a person who requires healthcare but
do not need to stay in the facility
 Classification
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Public
Private
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Nurse’s Roles:
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Administrator or manager
Assess and monitors patient’s health status
Provides direct care
Coordinates the care provided by others
Teaches patients and families
Plans, implements and evaluates the plan of care
Provides staff information
Coordinates discharge planning to ensure continuity of care
Provides specialized care
Makes referrals
nurse practitioner
clinical nurse specialist
researcher
Examples are clinics and offices
 Services
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diagnosis and treatment of minor illnesses
performing minor surgical procedures
providing obstetrical care
well-child care
counselling
referrals
Nurse’s roles:
Health assessments
 Performs technical procedures
 Assists physician
 Provides health education
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clinics or centers operated by a group of health
providers who work together or by a nurse
practitioner
 may be located in hospitals, shopping malls or other
community agencies
 Nurse’s roles:
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Assessments of health status
Assists primary care provider
Provides direct patient care
Performs technical services (administering medications)
Teaches patient and family
Plans, implements and evaluates the plan of care
Serves as patient advocate
One of the most rapidly growing areas of the
healthcare system.
 Prospective payment system of reimbursement is
available for this healthcare setting.
 Encourages early discharge from the hospital
 Nurse’s roles:
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Assesses home environment and the patient
Develops relationship based on mutual trust
Plans, implements and evaluates plan of care
Provides direct care
Coordinates care of others
Teaches patient and family;
Provides support for family members
Makes referrals
 Facilities
that provide healthcare and help with
the ADL for people of any age who are physically
or mentally unable to care for themselves
independently.
 Examples:
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transitional subacute care
assisted-living facilities
intermediate and long-term care
nursing homes
retirement centers
residential institutions for mentally and
developmentally or physically disabled
“aging in place”
 Nurse’s
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roles:
Serves as administrator
Coordinates the care provided by others
Provides direct care
Teaches patient and families
Plans, implements and evaluates the plan of care
Makes referrals
 Day-Care
Centers
 Mental health Centers
 Rural health Centers
 Schools
 Industry
 Homeless Shelters
 Rehabilitation Centers
 Respite
Care
 Hospice Services
 Voluntary
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Agencies
Alcoholics Anonymous
Cancer support groups
Reach to Recovery
 Parish
Nursing
 Government Agencies
 provide
healthcare services to veterans, and
military hospitals provide care to active
members of the armed forces and their
immediate families
- under the direction of the U.S. Department of
Health and Human Services.
 Centers
for Disease Control and Prevention
 National Institutes of Health (NIH)
 are
local, state, and federal agencies that
provide public health services at the local,
county, state, or federal level
 promote health
 prevent illness
 Entering
and leaving a healthcare setting are
experiences that produce anxiety for both
patients and family members.
 Two concepts in nursing care:
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Continuity of care
Community-based care
 consider
patient’s needs in his transition from
the acute care setting to care at home
 Anyone
who enters a healthcare setting take on
a new role.
 They also enter an environment in which they
are surrounded by strangers.
 Admission period corresponds to the orientation
phase of the helping relationship.
 Nurses much provide holistic care and establish
an effective nurse-patient relationship.
 Nurse acts as an advocate.
 Recognize
and take steps to reduce the
patient’s anxiety.
 Remember that the medical or surgical
condition for which the patient is being treated
is only one part of the patient’s life.
 Communicate with the patient as an individual
so that he or she can maintain his or her own
identity.
 Take time to learn who the patient being
admitted is.
 Encourage the patient’s family to participate.
ADMISSION
 Ambulatory
Care Facility – facilities where the
patient receives healthcare services but does
not remain overnight.
 GOAL: to provide patients who are able to
provide self-care at home w/ assistance as
necessary from healthcare providers.
 Activities: health promotion, health
maintenance, or medical or surgical treatment.
Complete a short health history in a reception area.
 Physical assessment is completed in an examination
room.
 Given diagnostic tests; may be immunized; may be
prescribed medications or may undergo minor
surgery.
 Health teaching including written instructions about
care at home, health promotion activities and how to
contact someone for further questions.
 Referrals to community agencies, support groups.
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 Screening
tests, teaching
and admission
procedures are usually
completed before the
patient enter the setting.
 Nurse’s Responsibilities:
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Assess what has been
done to the patient
Tailor care plan to the
patient’s needs
ADMISSION
 Begins
in the admitting office.
 Admission sheet is completed which contains
information about the patient.
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Full name
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Address
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Date of birth
Name of admitting physician 
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Gender
Marital status
Nearest relative
Occupation & employer
Financial status
Religious preference
Date & time of admission
Identification number
Admitting diagnosis
 Identification
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contains:
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bracelet is made
Identification number
Patient’s name
Physician’s name
important safety component during patient’s stay
identify patients who are irrational, comatose or
young
 Initial
interview is done
by the nurse.
Provides other information
about legal and ethical
components of care.
 Patient asked to sign forms
for consent to treatment
and allow hospital to
contact healthcare
insurance companies or
public agencies (Medicare).
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 During
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the initial interview:
Patient is asked for any advance directives (will or
power of attorney)
Disclosure of health information
Patient is also asked to provide names of family
members or friends.
 Patient’s
Bill of Rights is given and explained to
the patient.
 Addresses
the expectations, rights and
responsibilities of the patient while receiving
care in the hospital.
 Patient’s rights:
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To obtain information about one’s illness
To refuse medication or treatment
To receive considerate and respectful care
To privacy
To expect continuity of care when appropriate
 After
forms are completed, admission health
history and physical assessment are done by
the nurse.
 Laboratory or diagnostic procedures may be
done for unscheduled admissions.
 Position
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bed
For ambulatory
patients, the bed
should be in its
lowest position.
For stretcher-borne
patients, place the
bed in its highest
position. Ensure room
is arranged to allow
easy access to the
bed.
 Open
the bed by folding back the top linens.
 Assemble routine equipment and supplies
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Hospital admission pack
Hospital gown or pajamas
Equipment for vital signs (steth, sphygmo and
thermometer)
Height & weight equipment
Container for specimen
 Assemble
special equipment and supplies
 Adjust physical environment of the room.
 The
nurse is responsible for ensuring comfort
and well-being of the patient upon arrival in the
unit.
 Nurse completes:
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Admission assessment
Inventory of personal belongings
Documents the information on the admission
database
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Information is used to develop nursing care plan.
Also used as database for discharge planning and home
care.
 Patient
should be welcomed to the unit in a
courteous manner.
 Nurse needs to assess the needs of the patient
and family accompanying the patient.
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They must mutually agree about whether family
should be present during admission.
Common activities & responsibilities
 Transfers
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within the hospital:
from ER to a hospital room
from an ICU to a hospital room
from one floor to another
From one room to another room on the same floor
 Transfers
to and from acute care settings and
long-term settings
 Transfers from acute care settings to their
homes
 Transfers from ambulatory care to acute care
settings
 All
patient’s belongings must be transferred.
 Ensure that belongings are not misplaced or
lost.
 Patient’s chart, Kardex, care plan and
medications are re-labeled.
 Ensure patient’s comfort and safety.
 Nurse
must report care to the
other nurse in the new area.
 Report includes: patient’s name,
age, physicians, admitting dx,
surgical procedures, current
condition and manifestations,
allergies, medications,
treatments, laboratory data and
any special equipments. Nursing
care priorities and advance
directives are noted.
 Patient
is discharged from the hospital setting.
 A copy of the chart may be sent to the long-term
care facility.
 All patient’s belongings are carefully packed and
sent to the facility with the patient.
 Nurse from the hospital provides a verbal report
to the nurse at the long-term care facility.
Activities and Guidelines
Nurses must consider
that the patient may be
expecting a change
from dependent role to
a more independent
role.
 Purpose: to ensure that
patient and family
needs are consistently
met as the patient
moves from acute care
setting to care at home.
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 Assess
strengths and limitation of the patient,
the family or support person and the
environment
 Implementing and coordinating plan of care
 Considering individual, family and community
resources
 Evaluating effectiveness of care
 Planning
for discharge actually begins on
admission.
 Key: an exchange of information among the
patient, caregivers, and those responsible for
care while patient is in acute care setting and
after the patient returns home
 Nurse must ensure that family members are
taught the necessary knowledge and skills.
 Referrals to agencies to provide support and
assistance are essential.
(Need a formal discharge plan & referral to another agency.)
Lack of knowledge of the treatment plan.
 Social isolation
 Recently diagnosed chronic illness
 Major surgery
 Prolonged recuperation from major surgery or illness
 Emotional or mental instability
 Complex home care regimen
 Financial difficulties
 Lack of available or appropriate referral sources
 Terminal illness
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 Assessing
and identifying Healthcare Needs
 Setting goals with the patient
 Teaching
 Providing home healthcare referrals
 Evaluating discharge planning effectiveness
 Collect
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include the family
 Assess
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and organize data about the patient
the patient for discharge.
Factors to assess:
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Health data – establish a database (age, gender, ht/wt, etc.)
Personal data – Language to use, feelings about being
discharged, expectations for recovery, things to help in coping
with stress
Caregivers – caregiver’s age, gender, relationship, past
experiences w/ illness or treatment, values & beliefs, cultural
practices
Environment
Financial and support resources
 Assess
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the patient for discharge:
Other formats:
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Evaluate patient’s ability to carry out ADLs
Noted patient’s ability to carry out instrumental activities
of daily living.
 Consult
medical record and physician orders for
exact medication and treatment plan.
 Expected
goals of the
discharge plan are set
mutually and must be
realistic.
 If not mutually agreed
on, plan may fail.
 Example: a diet plan
that is mutually agreed
on by patient
 Important
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Self-care techniques
Medications
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Purpose and expected outcomes; write diet plan
Referrals
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Demonstrated, practiced and provided in writing (e.g.
wound dressing)
Diet
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Drug name, dosage, effects, purpose, frequency and S/E.
Procedures and treatments
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teaching topics:
Appointments to first visit w/ physician; follow-up care
Health status
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Physical and emotional effects of illness
 Teaching
must always be documented.
 For
reimbursement of home healthcare visits,
physician must write an order for all services
and patient must meet eligibility criteria.
 Information includes:
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Kind of surgery or injury
Medications
Patient’s physical and mental status
Significant social factors (e.g. Frail caregiver, no
caregiver)
Family’s expected needs
 Evaluation
of discharge planning is usually
conducted a few weeks after the patient goes
home.
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By telephone call
A questionnaire
Home visit
 Evaluation
works.
is crucial to ensure that the plan
 Patient
must sign a form that releases the
physician and healthcare institution from any
legal responsibility for his or her health status.
 Patient is informed of any possible risk before
signing the form.
 Patient’s signature must be witnessed and the
form becomes part of the patient’s record.
Thanks! 