Reflective paper Essay Example

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    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
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DISCHARGE PLANNING AND POST-DISCHARGE CARE AWARENESS 11

Nursing Reflective Practice Essay

Discharge Planning and Post-Discharge Care Awareness

Introduction

This essay will look into the aspect of discharge planning and then outline the difficulties encountered, as well as the role of the discharge nurse in the planning process. The core feature of the issue at hand pertains to the fact that discharge planning is very crucial. The reflection based on Gibbs Model will critically look into the poor discharge planning process at my hospital of placement practice. Of much interest will be to evaluate how awareness on the side of patients and relatives is in respect to post-discharge care at home to ensure the patient gains their full health and avoid rehospitalisation. Finally, recommendations will be made based on the critical reflection, as well as the literature review done to raise strategic measures that can be carried out to realise effective discharge planning.

Patient discharge without prior preparations can be disastrous particularly with critical illnesses that require care after discharge (Morris, Winfred and Young, 2012). The nursing practice in the present world is changing at an alarming rate due to the ever changing health care environment. This has prompted various interventions and strategies aimed at improving their practices in order to enhance recovery processes (Jordan and Snelgrove, 2011). Patient care is a critical practice among the registered nurses. The Australian Nursing and Midwifery Council (2006), states that RNs have the obligation of planning for care continuity, identifying and initiating appropriate referrals to after discharge to the external agencies and resources, as well as being responsible for creating awareness among their patients on appropriate issues that are necessary to learn in respect to their post discharge care.

On Gibbs model application constituting, Description; Feelings; Evaluation; Analysis; Conclusion and Action Plan (Recommendations) (Taylor, 2004): This reflective cycle looks into a personal experience in a hospital within Brisbane town regarding the discharge of critically ill patients. The assessment team responsible for this task to effectively approve discharge are given the mandate to determine the discharge planning requirements consisting the manner of returning home of the patients, necessary care, medication, probable community care available or accessible in the area of patient’s residence, and ways to manage their daily activities (Clancy, 2009).

Mrs Choi (autonym for study purposes) was a critically ill patient aged 68 years and of Japanese origin living in Australia with her husband on the outskirts of Brisbane. This patient was presented during the author’s placement with a knee injury that required some surgical procedure to remove some pus and body fluids clogging at the knee joint. On reviewing her medical file, it was evident that her case had been looked into by the assessment nurse three weeks ago, and there was no record of folding knee problem affecting her mobility. At this juncture, the doctor observed that Mrs Choi had problems using her left leg efficiently making her gait appear to be staggering. Further, on questioning her, it was evident that she never used any mobility aid. It is imperative to note that the patient could have benefited a great deal from assessment of her mobility capability prompting use of mobility aid (Howenstein and Sandy, 2012). Failure of the nurse initiating an effective communication with the patient to establish any prevailing problems blocked any probability of the issue being addressed (Saintsing, Gibson and Penningtong, 2011). Even the care nurse could have detected Mrs Choi’s problem, but it seems lack of a cordial relationship with the patient hindered effective interventions before discharge process commenced.

The evaluation process brought a scenario crucial for any practicing nurse professional to understand the negative effect of poor planning of patient discharge (Morris, Winfred and Young, 2012). Proper assessment on Mrs Choi could have resulted to effective intervention of her mobility problem, but due to disregarding some minor features of the treatment process, the problem persisted. Assessment failed to be applied effectively right from the primary nurse who was attending to Mrs Choi taking her to the toilets, as well as the nurse in pre-discharge assessment which could have established the bending problem of the knee making mobility a problem. Thus, it is highly prudent to enhance the vitality associated with effective discharge planning and patient-nurse communication during assessment to establish any arising issues (Han, Barnard and Chapman, 2009). Having effective and individualised discharge planning based on the sickness and level of treatment of the patient is imperative in reducing hospital stay length, as well as the rate of readmission. According to Shepperd et al. (2013), this also enhances the satisfaction of a patient and their relatives. In regard to critical care wards, most patients are in hospital for long durations and constant assessment and interactions makes the recovery process easy with arising issues being attended to appropriately.

On more analysis of the issue regarding discharge planning, the author’s experience in the general wards is no different. One’s a patient requests for discharge; majority of the nurses fails to take great consideration in full assessment. There is less emphasis on the post-discharge requirements and care of the patient, which may result into successive rehospitalisation due to poor recovery processes (Suzuki, et al., 2012). During my placement, there lacked effective corroboration between ward nursing staff, discharge liaisons and even the specialists to get information necessary to make effective decisions. It is imperative to note that collective intervention yields effective results with respect to incorporating the entire team in coming up with interventions to ensure safe discharge of patients to their homes or care facilities (Rhudy, Holland and Bowles, 2011). The nurse plays a crucial role in collaboration with discharge connections and making inquiries from the physician, as well as explaining to the patient and relatives on post-discharge requirements and care at home.

Irrespective of the wing where a registered nurse (RN) practices, discharge from hospital is similar and should be effective, safe, and a through requirement for every patient. In respect to emergency departments, Jordan and Snelgrove (2011) states that this is a challenging practice to the nurses, since the main focus is on solving the acute problem. The settings available normally does not support the participation of a nurse in respect to planning of discharge orchestrated by a lot of work, low priority put on planning discharge, as well as lacking sufficient time (Han, Barnard and Chapman, 2009). Nevertheless, the fact remains that nurses have a duty to play in making adequate preparation for discharge and failure to do so amounts to negligence in their practice (Han, Barnard and Chapman, 2009).

The Department of Health and Aging (2011) advocates for efficiency in nursing care practice with legislations geared towards ensuring effective patients’ care. High pressure among nurses in respect to discharging critical patients within a given timeframe, Rhudy, Holland and Bowles (2011) indicates that chances are high that discharged patients will be integrated back to the community without effective assessment, treatment, and with limited support or planning. Planning effectively during discharge is a crucial practice with nurses having a greater role in this due to the fact that they are the ideal discharge planners for their respective patients (Naylor and Keating, 2008). This is favoured by various reasons like having close, continuous contact with their patients, understanding priorities of the other respective health team members, as well as their observational and evaluation skills which are effective in the facilitation of discharge planning, implementation and evaluation of the whole plan (Rhudy, Holland and Bowles, 2011).

Based on this reflection and literature evaluated, it is worth stating that nurses need to be well acquainted with planning effective discharge from any given ward (Kalisch, 2006). A number of issues that relates to nurse practice emanate from lack of enough reflection or coming up with effective interventions for specific clinical cases and given patients. Suzuki et al., (2012) opines that with effective and well equipped nurses in discharge planning and management of the entire process, confidence on their role is improved making their care coordination more effective. Most of the nurses working at the hospital; where the author did the placement, were not used to being reflective practitioners. It was clear that no encouragement or training on their part concerning decision making and critical analysis of case scenario had taken place. They were just working to meet their duty requirements and not really attend to the exact needs of the patients (Rhudy, Holland and Bowles, 2011).

Effective communication and involvement with caregivers, as well as family members of the patient is another factor to be considered during discharge planning. According to Foust, Vuckovic and Henriquez (2012), relatives and caregivers are mostly an integral part in the transition from hospital settings to home on the patient’s side. There is need for transparency and great awareness in respect to the whole discharge planning and process to the patients. According to Foust (2007), information pertaining to diagnosis, medication to be administered, post-discharge care and check-ups to follow, as well as possible signs of complications are issues to be made clear to the relatives and caregivers. This is a critical and crucial intervention for purposes of ensuring full recovery and minimise chances of rehospitalisation. The process of discharge planning is not an isolated one and ought to be integrated into the assessment tools, care plans, as well as documentation to enable nurses save time and do away with duties duplication (Naylor and Keating, 2008). Most hospitals come up with discharge liaisons and allied health staff pooled from across the hospital staff to effectively assist the nurses realise proper discharge planning. Effective discharge plans will ensure patient’s comfort, be informed, feel supported and improve reintegration back to the community with minimal chances of rehospitalisation (Howenstein and Sandy, 2012). Thus, it is evident from this reflection and literature reviewed that corroboration of discharge staff and nurse practitioners to look into post-discharge requirements and ensure every aspect of it is well looked into.

In conclusion, this critical reflection has looked into the aspect of discharge planning in the hospital settings. Effective discharge planning for all patients revolves around effective practices and interventions carried out by the primary nurse (Foust, 2007). Thus, it is worth noting that this is a core competency of a registered nurse with various challenges encountered being addressed with effective interventions. With a critical use of the Gibbs Reflective Model, this essay has established the fact there are gaps lingering in the discharge planning procedure that calls for effective consideration. With effective recommendations as outlined and eventual implementation; it is paramount that discharge planning processes can achieve their goals of ensuring discharge of patients on recovery road and no complications would result later. This case scenario coupled with the critical analysis, and reflection inspired the author as a RN to realise the effective nature of a discharge planning process in regard to achieving a holistic and quality care of any given patient.

References

Australian Nursing and Midwifery Council (ANMC) (2006). National competency standards for Registered Nurse. Canberra, A.C.T.: Australian Nursing and Midwifery Council.

Clancy, C. M. (2009). Reengineering hospital discharge: A protocol to improve patient safety, reduce costs and boost patient satisfaction. American Journal of Medical Quality, 24(4): 344-346.

Department of Health and Aging (2011). National health reform: Progress and delivery, September 2011. Accessed May 5, 2014 from <http://www.yourhealth.gov.au>.

Foust, J. B. (2007). Discharge planning as part of daily nursing practice, Applied Nursing Research, 20(20: 72-77.

Foust, J. B., Vuckovic, N. and Henriquez, E. (2012). Hospital to home care transition: Patient, caregiver, and clinician perspectives. Western Journal of Nursing Research, 34(2): 194-212.

Han, C. Y., Barnard, A., and Chapman, H. (2009). Discharge planning in the emergency department: A comprehensive approach. Journal of Emergency Nursing, 35(6): 525-527.

Howenstein, J. S. and Sandy, L. (2012). Case management and the expanded role of the emergency nurse. Journal of Emergency nursing, 38(5): 454-459.

Jordan, S. and Snelgrove, K. (2011). Transition from hospital to home: Development of a settling service for the Emergency Department and the Acute Assessment Unit. Asia Pacific Journal of Health Management, 6(20: 51-56.

Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality, 21(4): 306-313.

Morris, J., Winfred, L. and Young, K. (2012). Registered nurses; perceptions of the discharge planning process for adult patients in an acute hospital. Journal of Nursing Education and Practice, 2(1): 28-38.

Naylor, M. and Keating, S. A. (2008). Transition care. American Journal for Nursing, 108(9): 58-63.

Rhudy, l. M., Holland, D. E. and Bowles, K. H. (2011). Illuminating hospital discharge planning: Staff nurse decision making. Appl Nurs Res. 23(4): 198-206.

Saintsing, D., Gibson, L. M. and Penningtong, A. W. (2011). The novice and Clinical decision-making: how to avoid errors. Journal of Nursing Management, 19(3): 354-359.

Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D. and Barras, S. L. (2013). Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2013, 1: 1-91.

Suzuki, S., Nagata, S., Zerwekh, J., Yamuguchi, T., Tomura, H., Takemura, Y. and Murashima, S. (2012). Effects of a multi-method discharge planning educational program for medical staff nurses. Japan Journal of Nursing Science, 9(2): 201-215.

Taylor, B. (2004). Reflective practice: A guide for nurse and midwives. Maidenhead: Open University press.

Appendix

The Gibbs Reflective Model (1988)

reflective paper

(Source: Taylor, 2004).

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