Nurse Led Discharge Research Paper
Respiratory Discharge Nurse Specialist
(Nurse Led Discharge)
A Concept Paper for the course Evolving Roles of the Nurse in Education, Practice and Research
Raymund Christopher R. dela Peña
Saint Louis University
Background
Patients who are well enough for discharge are sometimes spending hours or days longer than they needed to in hospital waiting for the next doctor’s ward round. At the same time, patients in the emergency department are waiting for a bed to become available so they could be admitted to a ward. This led to frustrations for both patients and staff. A nurse-led discharge could be the answer to these problems.
Nurse led discharge is a process that involves nurses assessing the patient, liaising with the …show more content…
multi-disciplinary team and planning timely discharge based on an agreed clinical management plan. It may also involve the writing of discharge letters, making follow up calls and giving advice to patients and carer and other health and social care professionals involved in the person’s care (Lees, 2004). Also the term ‘nurse-led discharge may imply that discharging patients is an interdisciplinary activity. Therefore, it is important that the constructs of nurse-led discharge should be understood from professional to organisational perspectives.
The achievement of nurse-led discharge is one of the key roles shaping the future of nursing.
Although there have seen development in nursing roles, discharge planning has rarely been seen as an area ripe for new roles. However, there are clear benefits for the patients, nurses and trusts in developing a nurse-led discharge and a discharge nurse specialist.
Nurse led discharge is about nurses taking responsibility for initiating, driving and following through on the decision to discharge which may be carried out in partnership with medical colleagues and within clear protocols. This culture change of nurses taking ownership of driving patient discharge has real potential to make far reaching changes in future reform and modernisation of service …show more content…
delivery.
Objectives
1. To expedite safe and effective patient discharge that meets the needs of patients and significant others.
2. To empower nurses to work in partnership with their patients, so that they can aid the patient to take ownership in their own recovery and set goals which can be clarified, discussed and agreed in advance.
3. To promote interdisciplinary team working.
4. To include the community teams in complex discharge planning by inviting them to attend case conferences.
5. To utilise the knowledge and skills held by the nursing teams.
6. To reduce the patients length of stay and avoid untoward delays in discharge and maximise use of the Trusts bed capacity.
Advantages
1. It promotes effective inter-disciplinary working.
2. It makes effective use of nursing knowledge and skills.
3. It allows patients to be discharged as soon as they are ready.
4. It increases bed availability through prompt discharge.
Facility Profile Gabriela Silang General Hospital is a 100 bed capacity, tertiary level government hospital. Located at Tamag, Vigan City, Ilocos Sur, it serves as a base and training hospital for medical and nursing schools in the locality.
Department Profile
Medical Ward-Respiratory Unit caters to both male and female adult patients with respiratory diseases like asthma, bronchitis, pneumonia and with a separate isolation room for patients with tuberculosis.
Organizational Chart
Description
Discharge Nurse Specialist
An advance nurse practitioner who identify clients who require discharge planning, enable the problem-free transfer of patients from one facility to another and constantly review and determine the use of resources such as staff and medical facilities which are required to maintain the quality of care for the patient outside the hospital.
Qualifications
1. Must possess a Bachelor’s Degree in Nursing from an accredited college or university.
2. Must be licensed as a Registered Nurse in the Philippines.
3. Must have, as a minimum, 3 years hospital experience.
4. Must have Master’s degree in Nursing preferably major in Nursing Administration or Medical-Surgical Nursing.
5. Has the ability to assess and make critical decisions following training and competency assessment to safely select patients on which to use the general discharge protocol.
6. Can identify the key principles for safe discharge.
7. Demonstrate awareness of the Trust Policy & legal requirement to facilitate safe discharge.
8. Able to complete all relevant documentation associated with nurse led discharge.
9. Demonstrate effective communication skills.
10. Identify the need for referral & instigate referral to other agencies.
Responsibilities
1. Assess needs of patient/family beginning on the day of admission and continue assessment during hospitalization.
2. Anticipate needs/services: -Respiratory equipment -Hospital bed -Wheel chair -Walker -Home health nurse -Home PT/OT/ST
3.
Involve the patient/family in the discharge process.
4. Discuss with physician the discharge plan and obtain orders if needed.
5. Contact appropriate personnel with orders.
6. Provide written and verbal instructions at the patient/family 's level of understanding.
7. Verbally explain instructions to patient/family prior to discharge and provide patient/family with a written copy.
8. Ascertain that patient has follow-up care arranged at discharge.
9. Provide verbal and written information on what signs and symptoms to observe and when to contact the physician.
10. Assess if any community resources should be utilized (i.e.: Home Health Nurse), and contact appropriate personnel.
11. Document all discharge teaching on Discharge Instruction Sheet and Nursing notes.
12. Develop, implement, evaluate, and direct Discharge Planning and Care Coordination services, in accordance with current rules, regulations, and guidelines.
13. Assess and assure appropriateness of post discharge services needed, utilizing patient demographics, clinical information and insurance requirements.
14. Effectively communicate and coordinate care with interdisciplinary team members, clinical staff, physicians, patients and
families.
15. Develop methods for coordination of discharge planning with other clinical and patient
16. Development of preliminary and comprehensive assessments of the discharge needs of each client/resident.
17. Ensure that all personnel involved in providing care to the client/patient are aware of the client/resident’s discharge plan and educational needs.
18. Provides/collaborates with educational and community resources to introduce and educate clients/residents, hospital staff/partners and /or contractors to the needs of the client/resident.
19. Maintains effective relationships with referral providers.
20. Monitors admissions for anticipated length of stay & discharge date.
21. Ensure all related paperwork has been initiated.
22. Ensures that here has been contact with the case manager, social worker or other discipline with identified needs requiring intervention.
23. Monitors unit discharge variance logs & assists with reporting of outcomes to quarterly goals & establishing new goals.
24. Addresses trends to variances, identified from internal survey and develop quality improvement projects as appropriate to improve discharge process for the unit.
References
Lees L (2004) Making nurse-led discharge work to improve patient care. Nursing Times. 100, 37, 30-32
"Making nurse-led discharge work to improve patient care." www.nursingtimes.net. N.p., n.d.
Web. 28 May 2014. <http://www.nursingtimes.net/Journals/2013/02/15/m/s/r/040914Making-nurse-led-discharge-work-to-improve-patient-care.pdf>.
(Nurse Led Discharge)
A Concept Paper for the course Evolving Roles of the Nurse in Education, Practice and Research
Raymund Christopher R. dela Peña
Saint Louis University
Background
Patients who are well enough for discharge are sometimes spending hours or days longer than they needed to in hospital waiting for the next doctor’s ward round. At the same time, patients in the emergency department are waiting for a bed to become available so they could be admitted to a ward. This led to frustrations for both patients and staff. A nurse-led discharge could be the answer to these problems.
Nurse led discharge is a process that involves nurses assessing the patient, liaising with the …show more content…
multi-disciplinary team and planning timely discharge based on an agreed clinical management plan. It may also involve the writing of discharge letters, making follow up calls and giving advice to patients and carer and other health and social care professionals involved in the person’s care (Lees, 2004). Also the term ‘nurse-led discharge may imply that discharging patients is an interdisciplinary activity. Therefore, it is important that the constructs of nurse-led discharge should be understood from professional to organisational perspectives.
The achievement of nurse-led discharge is one of the key roles shaping the future of nursing.
Although there have seen development in nursing roles, discharge planning has rarely been seen as an area ripe for new roles. However, there are clear benefits for the patients, nurses and trusts in developing a nurse-led discharge and a discharge nurse specialist.
Nurse led discharge is about nurses taking responsibility for initiating, driving and following through on the decision to discharge which may be carried out in partnership with medical colleagues and within clear protocols. This culture change of nurses taking ownership of driving patient discharge has real potential to make far reaching changes in future reform and modernisation of service …show more content…
delivery.
Objectives
1. To expedite safe and effective patient discharge that meets the needs of patients and significant others.
2. To empower nurses to work in partnership with their patients, so that they can aid the patient to take ownership in their own recovery and set goals which can be clarified, discussed and agreed in advance.
3. To promote interdisciplinary team working.
4. To include the community teams in complex discharge planning by inviting them to attend case conferences.
5. To utilise the knowledge and skills held by the nursing teams.
6. To reduce the patients length of stay and avoid untoward delays in discharge and maximise use of the Trusts bed capacity.
Advantages
1. It promotes effective inter-disciplinary working.
2. It makes effective use of nursing knowledge and skills.
3. It allows patients to be discharged as soon as they are ready.
4. It increases bed availability through prompt discharge.
Facility Profile Gabriela Silang General Hospital is a 100 bed capacity, tertiary level government hospital. Located at Tamag, Vigan City, Ilocos Sur, it serves as a base and training hospital for medical and nursing schools in the locality.
Department Profile
Medical Ward-Respiratory Unit caters to both male and female adult patients with respiratory diseases like asthma, bronchitis, pneumonia and with a separate isolation room for patients with tuberculosis.
Organizational Chart
Description
Discharge Nurse Specialist
An advance nurse practitioner who identify clients who require discharge planning, enable the problem-free transfer of patients from one facility to another and constantly review and determine the use of resources such as staff and medical facilities which are required to maintain the quality of care for the patient outside the hospital.
Qualifications
1. Must possess a Bachelor’s Degree in Nursing from an accredited college or university.
2. Must be licensed as a Registered Nurse in the Philippines.
3. Must have, as a minimum, 3 years hospital experience.
4. Must have Master’s degree in Nursing preferably major in Nursing Administration or Medical-Surgical Nursing.
5. Has the ability to assess and make critical decisions following training and competency assessment to safely select patients on which to use the general discharge protocol.
6. Can identify the key principles for safe discharge.
7. Demonstrate awareness of the Trust Policy & legal requirement to facilitate safe discharge.
8. Able to complete all relevant documentation associated with nurse led discharge.
9. Demonstrate effective communication skills.
10. Identify the need for referral & instigate referral to other agencies.
Responsibilities
1. Assess needs of patient/family beginning on the day of admission and continue assessment during hospitalization.
2. Anticipate needs/services: -Respiratory equipment -Hospital bed -Wheel chair -Walker -Home health nurse -Home PT/OT/ST
3.
Involve the patient/family in the discharge process.
4. Discuss with physician the discharge plan and obtain orders if needed.
5. Contact appropriate personnel with orders.
6. Provide written and verbal instructions at the patient/family 's level of understanding.
7. Verbally explain instructions to patient/family prior to discharge and provide patient/family with a written copy.
8. Ascertain that patient has follow-up care arranged at discharge.
9. Provide verbal and written information on what signs and symptoms to observe and when to contact the physician.
10. Assess if any community resources should be utilized (i.e.: Home Health Nurse), and contact appropriate personnel.
11. Document all discharge teaching on Discharge Instruction Sheet and Nursing notes.
12. Develop, implement, evaluate, and direct Discharge Planning and Care Coordination services, in accordance with current rules, regulations, and guidelines.
13. Assess and assure appropriateness of post discharge services needed, utilizing patient demographics, clinical information and insurance requirements.
14. Effectively communicate and coordinate care with interdisciplinary team members, clinical staff, physicians, patients and
families.
15. Develop methods for coordination of discharge planning with other clinical and patient
16. Development of preliminary and comprehensive assessments of the discharge needs of each client/resident.
17. Ensure that all personnel involved in providing care to the client/patient are aware of the client/resident’s discharge plan and educational needs.
18. Provides/collaborates with educational and community resources to introduce and educate clients/residents, hospital staff/partners and /or contractors to the needs of the client/resident.
19. Maintains effective relationships with referral providers.
20. Monitors admissions for anticipated length of stay & discharge date.
21. Ensure all related paperwork has been initiated.
22. Ensures that here has been contact with the case manager, social worker or other discipline with identified needs requiring intervention.
23. Monitors unit discharge variance logs & assists with reporting of outcomes to quarterly goals & establishing new goals.
24. Addresses trends to variances, identified from internal survey and develop quality improvement projects as appropriate to improve discharge process for the unit.
References
Lees L (2004) Making nurse-led discharge work to improve patient care. Nursing Times. 100, 37, 30-32
"Making nurse-led discharge work to improve patient care." www.nursingtimes.net. N.p., n.d.
Web. 28 May 2014. <http://www.nursingtimes.net/Journals/2013/02/15/m/s/r/040914Making-nurse-led-discharge-work-to-improve-patient-care.pdf>.