Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

Families are rapidly becoming unpaid givers of complex care. Using McKeehan & Coulton's systems model, this critique reviews the evolution of the structure and processes of discharge planning programmes. It explores three common assumptions: discharge planning programmes are cost-effective, allow for enhancement of patients' and families' quality of life, and ensure continuity of care between hospital and community. Funds are saved due to decreased lengths of initial hospital admissions and readmission rates. However, the cost of additional hospital and community resources is rarely considered. Little evidence supports the concept that discharge planning directly affects a patient's health status. Patients and families often do not perceive the same level of benefit from discharge planning as do health professionals. Several issues surrounding research methodologies used in the reviewed studies are identified. Of particular concern is the lack of qualitative research into patients' and families' experiences. The critique concludes with an exploration of ethical issues and challenges arising from increased emphasis on cost-effective discharge planning. These include patients' rights, provision of sufficient human, social and financial resources, improved hospital–community communications, and control over hospital-developed but community-implemented programmes.     

Discharge planning and follow-up care: the asphyxiated infant.

Discharge planning and follow-up care of the asphyxiated infant is a complex process. Models of discharge planning, team member responsibilities, and teaching responsibilities are components of hospital discharge plans. Special care needs of these infants may include vision, hearing, immunizations, seizures, medications, and feeding. Families and health care professionals need to be familiar with programs providing financial resources for care of the infant such as private insurance, prepaid health care, Medicaid, Medical Needy program, Children with Special Health Care Needs (CSHCN), federal legislation mandating education and services for high-risk infants (PL 99-142 and PL 99-457) and intervention programs. Families returning to Newborn Follow-up programs become acquainted with a variety of professionals and types of neonatal and infant assessments. Providing teaching materials and information regarding special health problems, services and outcome, as it becomes known, is the responsibility of the extended health care team of nurses, physicians, home health services, psychologists, and therapists.     

Discharge planning and home care for low-birth-weight infants.

This article presents a review of discharge planning and home follow-up for low-birth-weight infants. The scope of the problem of low birth weight and postdischarge health status of low-birth-weight infants are presented in overview. Discharge planning and home care are detailed for healthy low-birth-weight infants and for low-birth-weight infants requiring various levels of technologic support in the home. Emphasis is on comprehensive discharge planning and home follow-up to facilitate continuity and quality of postdischarge care. Nursing's role is critical to the discharge planning and the postdischarge care process.     

Discharge planning as part of daily nursing practice.

Nurses deal with planning posthospitalization care within increasingly urgent focused environments and amid competing priorities. The purpose of this qualitative study was to examine nurses' discharge planning efforts as these occurred in practice. Eight nurses were observed and interviewed as they cared for selected patients. Major findings indicate that nurses' expectations of patients' progress guided their discharge assessments, teaching, and planning over time. Discharge teaching was a prominent part of daily practice that became more specific as hospital discharge neared. A gap between observed and documented discharge planning efforts existed, which poses significant challenges for nurses in many positions.     

Vitamin B12 deficiency: issues in nursing care.

Vitamin B12 deficiency is a relatively common occurrence with potentially devastating consequences. The wide range of etiologies and symptoms makes it imperative for the nurse to use a comprehensive approach to assessing and managing the patient with vitamin B12 deficiency.     

Spiritual care: an element in nursing care planning

Nursing has recognized spirituality as an aspect of holistic patient care but little has been written on the understanding of this concept within the holistic approach. In a discussion of this issue, three basic questions are addressed. Thesequestions include‘What is spirituality?’,‘How do patients express their spirituality?’, and‘How can spiritual care be incorporated into a plan of care?’Drawing upon nursing and health-related literature, an outline of the concept of spirituality is drawn and five broad areas of expression are described. The nursing process is used to demonstrate how spirituality can be incorporated into the patient's plan of care.     

Communication issues and advance care planning

OBJECTIVES: To provide practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. DATA SOURCES: Published articles, textbooks, and reports. CONCLUSION: The components of effective and compassionate care at the end of life require successful communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. IMPLICATIONS FOR NURSING PRACTICE: Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.     

Creutzfeldt-Jakob disease: diagnosis and nursing care issues

Creutzfeldt-Jakob disease is a rare, progressive brain disease that affects both men and women. It causes a relentless deterioration in the ability to function physically, mentally and emotionally. Many nurses will never have cared for patients with the disease and there are many misconceptions regarding its cause, progress and the implications for care. Blaire Smith-Bathgate examines these issues.     

Liver transplantation: issues and nursing care requirements

Liver transplantation has evolved into an accepted treatment for many suffering from end-stage liver failure. The complex nature of the liver results in every organ system being impacted by either the failing or the transplanted liver. Organ shortage remains problematic, and work to ensure maximizing the organ donor pool as well as the success of each organ transplant continues. The clinical care and condition of the patient before transplant can impact the outcome after transplant. Nurses can play an integral role in early identification of graft dysfunction, rejection, or infection. Because of the intimate and large amount of time that the nurse is at the patient’s bedside, he or she is often in a position to monitor for potential risks to the patient and take corrective action.     

Home care nursing: professional and political issues

Concern for quality, cost, and access dominate the health care system in the eighties. State and national actions, demographic changes, and technological advances are converging to create many changes in the home care delivery system. Knowledgeable nurses can influence the evolution of home care services to assure that patients receive appropriate acute and long term home care services. Concern for quality care, changing patient needs, and availability of care are the major issues facing home care nursing in the eighties, and will continue to be into the nineties. Reimbursement policies of third party payers, medicare/medicaid regulations, state licensing, employer benefit programs, state health programs, home health care providers, professional/trade associations, and consumer advocacy groups are some of the key forces reshaping the practice of home health nurses. Knowledge of these factors will enable nurses to influence effectively the design of institutional and governmental policies which affect the care nurses deliver to patients at home.     

Methodological issues in researching palliative care nursing practice.

The purpose of this integrative review was to describe the research conducted by nurses since the mid-1990s on nursing practice in the context of palliative/end-of-life care, identify promising methodological developments as well as methodological challenges, and propose strategies to support the development of this field of nursing research. A search of databases resulted in 121 research reports published between 1995 and 2003. Studies were included if the lead author was a nurse and the focus was nursing practice or nurses' attitudes about providing palliative or end-of-life care. Relatively few studies included patients, there were limitations in the data-collection methods used, and there was a lack of studies evaluating palliative care nursing. An emphasis on the interdisciplinary nature of palliative care may be hindering nurses from examining the effectiveness of nursing interventions. Increased attention should be given to examining the efficiency and effectiveness of nursing interventions to ensure the best outcomes for patients and their families.     

Orthopedic trauma: critical care nursing issues

Orthopedic trauma is frequently encountered by critical care nurses as trauma team members providing care to the severely injured. Through actual case examples, the role of the critical care nurse and orthopedic trauma management is reviewed. Focus is on unstable pelvic fractures, extremity fractures, compartment syndrome, rhabdomyolysis, mangled extremities, gunshot-wound fractures, and damage-control orthopedics.