Download Chapter 20

Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 20
Admission, Transfer, and Discharge
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Patient Reactions
to Admission
 Fear of the unknown
 Anxiety
 Child care concerns, effects on job, cost,
separation from others
 Loss of control over modesty, privacy,
activities, diet, hours of sleep
 Loss of identity
 Just one of many patients, just a number
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Situations Making Patients Feel
Out of Control




Constant flow of visitors
Sleeping in a different bed
Using a different toilet
Eating whatever food is provided, regardless
of how it was prepared
 Being awakened during the night for provision
of nursing care
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Interventions to
Decrease Patient Anxiety
 Encourage patients to ask questions and look
for signs that they understand the answers
 Provide a brief, factual explanation of the
patient’s diagnosis
 Avoid the use of medical terminology unless
patient understands it
 Provide reassurance without giving false
reassurance
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Questions New Patients May Have
 What is wrong with me? What is my unknown
diagnosis? What does it mean?
 What tests, procedures, treatments, or
surgeries will I undergo?
 Will there be discomfort or pain?
 Who are all these people who keep coming
into my room, one after another?
 How long will I have to be here?
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Interventions to
Protect Patient Privacy
 Protect modesty while assisting patient to
dress or undress
 Always knock before entering patient room
 Pull drape and close door during care
 Allow patient to wear own pajamas
 Deliver same gender care if possible
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Initial Contact with Patient
at Admission
 Use positive approach and smile
 Avoid talking rapidly and being in a hurry
 Avoid letting unpleasantness show in speech,
facial expression, or body language
 Introduce self and state your credentials
 Shake the patient’s hand
 Make brief eye contact and speak clearly
 Address patient by surname
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Providing Culturally Competent Care
 Never use first names to address patient
 Avoid use of slang; use common language
 Provide an interpreter in cases of language
barriers
 Do not use ethnic dialect unless fluent in it
 Use eye contact judiciously
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Providing Culturally
Competent Care (cont.)
 Position self so patient can see face and read
lips
 Pay attention to patient’s facial expressions
and nonverbal communication
 Exhibit respect for patient beliefs
 Clarify patient information you do not
understand
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Multiple Choice Question
Which of the following is an appropriate
guideline for providing culturally competent
care?
A. Call patients by their first name
B. Do not use ethnic language unless
fluent in it
C. Use correct medical terms whenever
possible
D. Keep eye contact with patients at all times
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Answer
B. Do not use the ethnic language unless
fluent in it
Rationale: Patients should be called by Mr.,
Mrs., or Ms. and their last name. Simple
terminology should be used with few medical
terms unless patient knows the term. Eye
contact should be used judiciously and
according to the patient’s cultural view.
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Demographic Patient Information
Obtained at Admission







Full name
Social Security number
Age
Date of birth
Residential address
Telephone number
Next of kin name and contact information
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Demographic Patient Information
Obtained at Admission (cont.)





Religious preference
Place of employment
Insurance and billing data
Physician’s name
Reason for admission
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Admission Process
 Authority to treat
 Must be completed and signed
 Grants permission for treatment
 Minor—parent must sign
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Admission Process
 Identification bands
 Stays on the patient throughout the entire
hospitalization
 Allergy band—usually red
 Each institution will color code their bands to
indicate fall risk, anti-coagulation medication, type
and crossmatch, or limb restriction
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Information Included on the
Patient Identification Band







Patient name
Room number
Hospital ID number
Age
Birth date
Physician name
Any allergies on a separate band (red)
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Responsibilities
During Admission





Introduction
Admission kit
Data collection
Data analysis
Discharge planning
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Introduction






Greet warmly, friendly with a smile
Introduce yourself, give credentials
First impressions are important
Check ID
If roommate introduce to each other
Orient patient and family to room
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Admission Orientation Checklist







Location of the nurse’s station
How to use the call light and intercom system
Location of the bathroom
How to use the telephone
How to operate the bed
How to adjust lighting
How to operate the television and radio
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Admission Orientation
Checklist (cont.)






Location of personal care items
Times meals are served
Location of cafeteria and snack machines
Hours that you will be his or her nurse
Any policies that apply to the patient or family
When the physician normally makes visits
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Admission Kit




Provide patient with kit
Bedpan or urinal?
Provide assistance to change clothing
Any valuables? Eyeglasses, dentures,
contacts, wallet, jewelry…..
 Complete inventory list—pt. signs
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Data Collection
 Subjective
 Objective
 This assessment provides a baseline against
which changes in patient condition, both
improvement and deterioration, can be
measured
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Data Analysis
 Analyze collected data
 Identify problems
 Potential problems—patient may be at risk of
developing
 Nursing care plan
 Discharge planning needs to be initiated
during the admission process
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Discharge Planning




Patient’s living arrangements
Physical limitations,
Ability to perform ADL’s
Use this information to determine needs
patient may have at time of discharge
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Typical Discharge Process




Obtaining a physician’s order
Notifying the business office of discharge
Reconciling the patient’s medications
Providing discharge instructions, prescriptions,
patient teaching
 Assisting the patient to gather his or her
personal belongings and valuables
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Typical Discharge Process (cont.)
 Documenting the patient’s condition,
including vital signs
 Assisting the patient to the car
 Documenting the time of discharge and
method of transportation
 Notifying housekeeping so that the room can
be cleaned
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Discharge Planning






Teaching about the patient’s illness
Teaching dietary alterations
Teaching safe and effective use of medications
Teaching how to perform treatments
Teaching methods of adaptation
Recommending various support groups
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Discharge Planning (cont.)
 Providing the patient with list of appropriate
community resources
 Making referrals
 Assisting the family to find a long-term care or
assisted living facility
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Physician’s Discharge Order
 If patient decides to leave hospital before
physician discharges
 AMA—Against medical advice
 Educate patient—explain importance
 If patient insists—must sign AMA form
 If refuse to sign—document
 Notify physician of patient’s decision
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Reconcile Medications
 There are no duplications in ordered
medications
 Dosages are correct and any differences or
changes in dosage were intended
 All previous home medications have either
been continued or discontinued, not
overlooked
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Reconcile Medications
 Prescriptions have been provided for new
medications
 A written list of medications is provided to the
patient
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Discharge Instructions





When to return to physician for follow-up
List of medications and how to take them
Modification of diet or activity level
Signs and symptoms of worsening condition
Care or treatment to continue at home
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Notification of Business Office
 Assess records for completeness
 Any forms need to be signed
 Make payment arrangements
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Gathering of Belongings and
Valuables







Check inventory list
Obtain any items in hospital safe
Have patient sign receipt of valuables
Remove any tubes or equipment
Document
Escort patient
Notify housekeeping for terminal cleaning
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Transfer Within a Facility







Obtain physician order for transfer
Explain reason for transfer to patient/family
Reconcile list of patient medications
Gather patient belongings, supplies, chart
Complete transfer summary form
Report patient condition to new nurse
Transfer patient with belongings and
document time of transfer
Copyright © 2011 F.A. Davis