The discharge planning process is highly imperative in ensuring a smooth, rapid and even rapid transition of the patient from one healthcare environment to another. The discharge process entails the arrangement of necessary resources, social work evaluation, high-risk screening operations, patient advocacy, chart documentation, collaboration/consultation, family and patient awareness and most importantly counseling. The process is, therefore, complex and seriously requires a personnel with a large assortment both organizational and clinical skills to tackle the diverse patient needs, healthcare schemes, and patent's families and also to promote the optimum functioning of support systems, patients, and families. Delay factors may be intrinsic for instance when caused by long waits for chronicity declaration, unit transfers, and discharge plan documentation and discharge summaries. The delays factors may also be extrinsic, therefore entailing, delay in accessing home care resources, rehabilitative services, palliative care and convalescence. With respect to that, this project, therefore, aims at the creation of the position of a discharge nurse to reduce wait times, enhance patient care and nursing satisfaction (Petitgout, 2015).
The project design takes on a qualitative study design. It aims at establishing the existing planning practices with regards to discharge procedures conducted by nurses in rehabilitation and acute facilities establish the constraints in discharge planning executions and suggest the constituents and requirements entailed in the creation of a discharge nurse position and an efficient discharge planning scheme. The project will additionally offer very imperative information crucial to the development of the discharge position and planning strategy. Therefore, due to its qualitative nature, the project will incorporate the views of patients regarding the discharge nurse position to enable us to have a full picture.
The Sample or Patient Population
The study involved 100 patients from the lowest, average and highest unplanned public facilities with discharge procedures, with or without a discharge nurse. These patients or the study participants were the most probable to fully understand the discharge systems and, therefore, offer reliable and valuable feedback. Age and gender considerations were not applied in the selection of the study population. The patients were taken through necessary explanations to make the topic of concern very clear. Later on, they were involved in focus groups discussions consisting of twenty patients each. The patients were provided with guided open-ended questions which covered the existing practice regarding the discharge procedures at the facility, the barriers encountered due to the existing unplanned or planned discharge program and their suggestions regarding the creation of the discharge nurse position and the anticipated improvements. The participants were allowed to discuss and fully exploit their views (Spiva & Johnson, 2012).
As mentioned earlier, a focus group discussion was implemented to help understand the views of the patients with regards to the creation of a discharge nurse position, the limitations and components of effective discharge planning and finally the expected improvements. To properly analyze the collected data, content analysis was deployed since this strategy stressed sharing of the patient’s expressions and even the conceptual meaning (Spiva & Johnson, 2012).
Data Collection Process
Data collection process involved conducting focus group discussions at the public facilities after working hours. The discussions lasted one hour and were recorded with audio recorders only with the consent of the participating patients. The discussions were led by qualified health researchers. The participants were asked to express their opinions without any limitation with regards to the creation of a discharge nurse position at the facility. Discussions guide was used to enable a complete coverage of all the sub topics of interest. Finally the demographics of the study population including their professional experiences, gender and age were taken note of.
Data Analysis Process
All the interviews were accurately coded and effectively transcribed through the NVivO 7.0. This represents a mixed approach of thematic analysis and involved the application of grounded theory. First and foremost, a thematic analysis was carried out, and the important themes were established as per the existing patient discharge practice, the constraints, the suggestions and the benefits ("Implementing Care Coordination in the Patient Protection and Affordable Care Act", 2010). Under the barriers encountered in the creation of the discharge nurse position and discharge planning, the grounded theory was implemented to group the barriers into the social, healthcare professional, the system and finally the patients’ aspects (Petitgout, 2015). The theme identification and the coding procedure were carried out by different researchers in an independent manner. In the course of the analysis of the collected data, data in between themes were properly assessed to confirm or even disconfirm perspectives across the patients. To finally make sure that data analysis and data saturation were complete, additional checks were conducted on each completed discussion from the focus groups to enable the determination of whether another focus group was necessary.
The patients pointed out the many disorganized discharge programs in different facilities arising from the lack of the specialized services of a discharge nurse. Some facilities offered disease-specific discharge programs targeting only cancer, stroke, cardiovascular disease, kidney failure, and pulmonary disease patients. Other patients within the facilities, therefore, wait for long for the discharge processes to be completed and lack the valuable services of the discharge nurses (Spiva & Johnson, 2012). The patients attributed other factors which contributed to the ineffectiveness of the discharge processes as being the system factors, the patient factors and the social factors and the health facility factors. The other valuable services which these patients who are affected lacked are the important health education offered by these nurses, the follow-up programs after discharge and time reduction during waiting. Therefore, on a wider scale, these nurses facilitated improvements in surrounding education, positive nurse staff workflow and the preparations of the patients for discharge (Petitgout, 2015).
The creation of the position of the discharge nurse is very essential and, therefore, inevitable. The discharge nurse discharges their skills and offer services like personally taking the patient through the discharge procedure, reviewing documents which require completion before the patient is discharged and tackling the needs of the external hospital environment regarding the management of the patients care. Additionally, the discharge nurse ascertains whether the patient has understood the self-management and medication prescription details. Therefore, we can safely deduce that a discharge nurse can limit the cases of readmissions since the education, and awareness they offer enables the patient, and his or her family manage themselves outside the hospital setting. The relocation from the hospital setting to the home setting proves extremely overwhelming for both the family and the patient, therefore, the discharge nurse position is very fundamental to enable the admission nurse, and the bedside nurse performs their routine responsibilities even better.
Implementing Care Coordination in the Patient Protection and Affordable Care Act. (2010). POLICY BRIEF, 1-2.
Petitgout, J. M. (2015). Implementation and Evaluation of a Unit-Based Discharge Coordinator to Improve the Patient Discharge Experience. Journal of Pediatric Healthcare, 29(6), 509-517 9p. doi:10.1016/j.pedhc.2015.02.00http://dx.doi.org/10.1007/s11701-011-0276-5
Spiva, L., & Johnson, D. (2012). Improving Nursing Satisfaction and Quality through the Creation of Admission and Discharge Nurse Team. Journal of Nursing Care Quality, 27(1), 89-93. http://dx.doi.org/10.1097/ncq.0b013e318227d645
Wong, E., Yam, C., Cheung, A., Leung, M., Chan, F., Wong, F., & Yeoh, E. (2011). Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research, 11(1), 242. http://dx.doi.org/10.1186/1472-6963-11-242