The discharge liaison nurse at the interface of hospital and community nursing services

The organization of nursing into hospital and community services makes the smooth transition of care between hospital and community difficult to establish. This paper describes the function of discharge liaison nurses as one facet of a study designed to determine how hospital and community nurses perceive their provision of continuing patient care. Semi-focused interviews were conducted with 12 hospital nurses and 12 community nurses to explore their perceptions of discharge planning related experiences. Hospital and community nurses both relied on discharge liaison nurse to provide a link between hospital and community services. The practice of discharge liaison nurses as facilitators and co-ordinators of discharge planning are discussed.     

The development of a nurse-led liaison mental health service for older people in Chesterfield, Derbyshire, UK

Mental health problems are very common among older people in general hospitals. They are independent predictors of poor outcomes. Research indicates that appropriate interventions can improve outcomes. It is increasingly recognized that liaison mental health services have a key role in meeting the needs of older people in the general hospitals and educating and supporting staff. This paper describes aspects of the developmental and clinical work of a consultant nurse in developing a nurse-led liaison mental health service for older people in Chesterfield, Derbyshire, UK. It describes the impact of this service on referral rates. It also details the results of an audit of 206 referrals assessed by the consultant nurse in the second year of the service. The analysis of data collected provides a profile of aspects of the role of a liaison nurse including reasons for referral, psychiatric diagnosis and interventions recommended. This paper also, uniquely, documents mental health liaison into a community hospital. Implications for the development of services are discussed.     

Liaison nursing for stroke patients: results of a Dutch evaluation study

Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related outcomes. After the introduction of liaison nursing, hospital nurses completed a questionnaire on satisfaction with the liaison nurse. In addition, both before and after the introduction of liaison nursing, two groups of discharged stroke patients were interviewed by telephone. The records of these patients were also studied with respect to background characteristics and duration of hospital stays. The hospital nurses were, generally, positive about the liaison nurse and the job she did (e.g. they found that home care was better organized). Further, after the introduction of liaison nursing, more patients stated that their post-discharge needs had been discussed not later than 48 hours prior to discharge, and more patients said their aftercare had been discussed with community nurses. However, the number of patients whose medication had arrived at home on time had decreased. The results also indicated that there was no significant difference in the duration of stay between the before and after group. The overall conclusion is that the liaison nurses have been moderately successful in their jobs. However, since the study was conducted in only two Dutch hospitals, findings may not be representative of other settings. Future research on liaison nursing is therefore recommended.     

Development of the role of the pediatric oncology nurse practitioner in the Netherlands.

The role of the nurse practitioner is rather new in the Netherlands. This is certainly applicable to the nurse practitioner in pediatric oncology (NPPO). Currently, 7 NPPOs are working in 4 different hospitals in the Netherlands. They all have relatively different roles within their own organization, which are dependent on the specific structure and culture of the organization. The NPPO role is not intended to fill a gap in medical care; rather, it is filling a gap in care for children and parents due to the shift of care to the home environment following early discharge. In the future, research will be necessary to ask children and parents about their experience with the NPPO.     

The success of an integrated care programme for patients with ischaemic heart disease: the practice nurses' perspective of SHIP

Follow-up care of patients with angina and myocardial infarction after hospital discharge is known to be suboptimal across the UK. The employment of cardiac liaison nurses ensured timely notification of hospital discharge and good communication of each patient's current and planned care. The direct ongoing support of the liaison nurse was valued by more practice nurses than educational support meetings and the initial counselling skills course. The most important factor which enabled practice nurses to expand their role to provide post-hospital follow-up care was the support of the doctors in the practice. After the conclusion of the Southampton Heart Integrated Care Project (SHIP) and the withdrawal of cardiac liaison nurses, the lack of hospital discharge notification was the most important reason for practice nurses discontinuing follow-up care.     

新形势下健康管理中心护士素质与多元化角色

目的:探讨健康管理中心护士多元化角色在医院健康管理工作中心发挥的举足轻重的作用。方法:分析新形势下健康管理中护士多元化角色应具备的素质。结果:随着医学服务模式转变、服务的内涵和范围不断的延伸和扩大,健康管理中心护士崇高的职业道德、深厚的人文素养、良好的心理素质、扎实的理论基础、精湛的护理技术、良好的自我形象,已成为有别于医院传统科室封闭式临床护士的新型全科护理专业人员,其多元化角色的扮演,极大地提高了医院的健康管理水平和服务质量。结论:21世纪是知识经济时代,各种医疗改革正在逐步进行,护士只有充分认识时代的特点,不断地完善自身的知识结构和能力结构,转变思想观念、改变思维方式,建立全新的护理观念,将护理与健康、护理与人的生活方式、已有的知识与现代化手段相结合,在健康管理中心立足于角色的多元化,内强素质、外树形象,以促进医院健康管理工作顺利开展,使健康管理工作在医院和社会发挥更重要的作用。     

Evaluating quality of nursing care: the gap between theory and practice

The purpose of this article is to determine whether nursing practice, as judged by nurse peer reviewers, varies by type or location of hospital and to assess which aspects of practice tend to be most at variance with nursing theory. This article provides a framework of continued quality assessment and improvement that is based on prior research. Trained nurse peer reviewers carried out structured implicit review, which utilized their professional judgment to evaluate the process of nursing care for patients admitted to acute hospitals with heart failure or cerebrovascular accident. Findings show significant variations in the quality of nursing care and support the continued development of nursing quality assessment and improvement initiatives directed at reducing the gap between nursing theory and practice.     

Hospital and community liaison links in nursing: the role of the liaison nurse

Since the 1960s there has been an awareness of a 'care-gap' when patients are transferred between hospital and home. In the United Kingdom, attempts to improve continuity of care have included the development of the role of the hospital/community liaison nurse. The liaison role has evolved in different ways and no systematic evaluation has occurred. This paper reports the findings of an exploratory study into the structure and process of the liaison role. It is suggested that the role is effective in enhancing continuity of care, but that modifications accompanied by educational and organizational changes would improve current practice.     

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected,disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care.     

The impact of a liaison nurse on ICU nurses' perceptions of discharge planning.

The objective of the study was to examine the impact of a discharge liaison nurse on intensive care unit (ICU) nurses' perceptions of discharge planning. The discharge liaison nurse coordinated the discharge of patients from ICU to the ward, assisted with hospital discharge, provided clinical teaching and support to both ICU and ward nurses and supported patients and families during hospitalisation. A block intervention design was used. All ICU nurses within one Australian teaching hospital were surveyed prior to and following the implementation of the discharge liaison nurse. Measures included the perceptions of discharge planning scale and the general perceived self-efficacy scale. Following implementation of the liaison nurse, less nurses perceived that discharge planning in the ICU was premature (chi2(2, n=117)=7.759, p=0.021) and that ICU nurses lack an understanding of the discharge planning process (chi2(2, n=118)=15.557, p<0.001). Discharge planning was more frequently seen as the responsibility of the bedside nurse (chi2(2, n=115) =15.270, p<0.005) but there was greater recognition of discharge planning as a time consuming process (chi2(2, n=117)=8.560, p=0.015). Self efficacy in relation to discharge planning did not change over time. Some support was found for the role of the discharge liaison nurse in promoting attitudinal change towards discharge planning in the ICU. Future research is needed to investigate the processes by which the liaison nurse fosters attitudinal change and to document the actual discharge planning practices undertaken in ICU.     

上海市三级甲等医院麻醉护理的现状调查研究

目的通过调查上海市三级甲等医院麻醉护理的现状,对国内麻醉护理的发展提出建议。方法 2009年4—6月,我们采用自行设计问卷对上海市26所三级甲等医院麻醉科进行调查,包括基本资料,麻醉科工作及人力资源配置情况等。结果 26所医院中,19所医院现已开展麻醉护理,但麻醉护理人员的配备不足,且专业力量薄弱,所开展麻醉护理工作内容局限。结论开展麻醉护理应首先在法律、法规层面明确麻醉护士的职责、权利及义务,建立并完善专科护理人才的培养及认证体系,设立专科护理学术团体,从而促进麻醉护理全面的、可持续的和规范化发展。     

Weaving the seamless web of care: an analysis of parents' perceptions of their needs following discharge of their child from hospital

Changes in children's nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a 'seamless web of care' for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child's illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children's nursing services and how these can be overcome by using our present resources more imaginatively, in order to ensure the delivery of cost-effective and quality health care services in the best interests of local need.     

Acute coronary syndrome nurses: perceptions of other members of the health care team

Acute coronary syndromes (ACS) are a major health care problem and result in a large number of hospital admissions each year. Nurses across the NHS are being empowered to undertake a growing range of responsibilities but little research evidence exists related to the impact on patient care nor working practice with other health professionals. This paper reports part of the evaluation of a British Heart Foundation pilot project to place an 'ACS nurse' in participating hospitals. In each of 5 hospitals, 100 staff across accident and emergency, general medicine and cardiac specialities were sent a questionnaire. The response rate was 33%. Respondents felt that the ACS nurse role was beneficial to patient care and had little overlap with existing roles within the hospital. Support for nurse initiated thrombolysis was high, but comments reflected the on-going debate around accountability and training. Communication and problem solving were identified as key elements of the ACS nurse role. Findings in this study show support for the integration of an ACS nurse role as a way to provide improved care to ACS patients.     

Liaison nursing.

In reviewing my efforts to clarify the role of the nurse clinician as a psychiatric consultant in a hospital setting, I came away with many impressions. Inherent in my search was a desire to experiment with various means of providing nursing service and much of my time was spent examining the collaborative aspects of the nursing role that would add greater depth to patient care. This involved role experimentation and allowed me the opportunity to develop my role within the context of the guidelines of community organization and consultation in a hospital setting. Although much of the time I found that the liaison role has been aimed at the supportive level, I have also discovered that as I developed security in the role wherein I could function in new and more independent ways--the parameters of the role expanded. Whereas initially I envisioned working only with nursing staff, I have found myself collaborating with many disciplines and many levels of care givers and I have also been able to function collaboratively with other psychiatric liaison team members. Thus, at this time I see the liaison nurse functioning basically as a coordinator, who, at any time, may assume one or more of the following roles: 1) Integrator; 2) Provider of direct services; 3) Educator and consultant; 4) Change agent.     

Use of the 'BRASS' to identify ICU patients who may have complex hospital discharge planning needs

Intensive care unit (ICU) transition programmes and discharge liaison nurse roles have emerged because the move from the ICU to the general wards has been found to be problematic for patients, their families and even health care professionals As these programmes are costly, it is essential that they are delivered to those for whom positive outcomes are most likely to be achieved. This paper reports on the use of the Blaylock Risk Assessment Screening Score (BRASS) to identify ICU patients who are at risk of complex hospital discharge needs Use of BRASS at admission was not particularly specific: that is, it was not able to identify consistently those at risk of prolonged ICU and hospital stay and ICU readmission. BRASS was fairly sensitive, correctly identifying over 95% of individuals who did not have a prolonged hospital stay BRASS is easy to use, but may be no better than severity of illness scoring systems in identifying ICU patients who potentially have complex hospital discharge planning needs; if used, it should not be completed on ICU admission alone.     

The palliative care clinical nurse consultant: An essential link

This study describes the role of acute hospital palliative care nurse consultants and makes recommendations about future directions for the role development of this role. While the palliative care nurse consultant role is accepted in the acute setting there is little evidence or literature about what contributes to the success of this role. A three-phase study was undertaken to describe the role of palliative care nurse consultants in acute hospitals in Melbourne, Australia. The first phase of the three-phase study, involving in-depth qualitative interviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed using open-ended questions about aspects of their role and the interviews were thematically analysed. Four main themes were identified that clarified the role; being the internal link; being the lynch pin; being responsive and being challenged. The palliative care nurse consultants were the first point of introduction to palliative care and thus they saw a significant role in introducing the concept of palliative care to those requiring palliative care, their families and others. They are an important link between the settings of care required by people accessing palliative care—acute, in-patient palliative care and community care. The palliative care nurse consultants saw themselves in leadership positions that in some ways defy boundaries, because of the inherent complexity and diversity of the role. The palliative care nurse consultants’ role appears to be pivotal in providing expert advice to staff and people requiring palliative care, and connecting palliative care services both within the hospital and to external services.     

Current status of discharge planning activities and systems: National survey of discharge planning in Japan

Aim: We investigated the current situation of discharge planning in Japan and the variables related to the implementation of discharge planning. Methods: A questionnaire was mailed to 3268 general hospitals in 2001; 1359 hospitals were used as the subjects of analysis. Results: The majority of the hospitals experienced problems in terms of patients’ discharge (1313 or 96.6%). More than 90% of the hospitals described discharge planning activities. The most common professions involving discharge planning were ward nursing staff and physicians, and only 29.4% hospitals reported that a discharge planning department was established in their hospitals. More hospitals with these departments implemented almost all activities of discharge planning compared with hospitals without such departments. Implementation of discharge planning was also related to hospital size, affiliated institutions, implementation of home visits by medical staff, and nurse/patient ratios. Conclusion: This survey showed a high implementation rate of discharge planning activities but that departments for discharge planning have not been widely adopted. It is recommended that such departments should be established or that staff should be allocated to carry out discharge planning in order to assure the continuity of quality care for patients as they move among care settings.