Admissions, Transfers, and Discharge
Nursing Process and Admissions
The nursing process is a systematic, problem-solving approach that nurses use to identify, diagnose, and treat human responses to health issues. It's a continuous cycle, not a rigid, linear process.
During admission, transfer, or discharge, the nursing process remains integral to ensuring patient safety and quality of care. These transitions require careful assessment, planning, and intervention.
The nursing process adapts to various situations, providing flexibility in care delivery.
Assessment Phase During Admissions
Assessment is the initial and ongoing phase that starts at the beginning of the admission process. It's crucial for gathering comprehensive data.
It involves:
Taking vital signs: Establishes a baseline for monitoring the patient's physiological status.
Asking questions: Elicits information on medical history, current symptoms, and psychosocial factors. These questions should provide insight into the patient’s perspective.
Gathering history: Includes medical, surgical, family, and social history to identify potential risk or contributing factors.
Identifying the reason for admission: Determines the primary health concern that brought the patient to the facility.
Includes professional observations: Paying close attention to verbal and non-verbal communication to understand the patient’s emotional and mental state. These observations complement subjective data.
Patient Problems/Nursing Diagnosis
This stage occurs after the assessment phase and involves analyzing the collected data to identify the patient's health problems and needs.
Uses collected information to formulate the patient's main issue. This involves synthesizing data to create a clear picture of the patient's condition.
Nursing diagnoses, differentiate from medical diagnoses, focus on patient responses to health conditions. They guide nursing interventions.
Example: A patient has elevated blood pressure, but the nurse cannot diagnose hypertension. Instead, the nurse might identify a nursing diagnosis such as "risk for decreased cardiac tissue perfusion" related to elevated blood pressure.
Planning
This involves setting goals and outcomes and determining appropriate nursing interventions to address the patient's problems.
Determining what a nurse can do to help the patient's issue. This includes establishing priorities and selecting evidence-based interventions.
Example: If a patient is in pain, plan interventions to reduce pain, such as administering analgesics, repositioning, or using relaxation techniques.
Expected outcome: Goals should be specific, measurable, achievable, relevant, and time-bound (SMART). For example, "Pain will be reduced to a level of 3 on a scale of 0-10 within one hour after intervention."
Interventions
These are the specific actions that the nurse performs to implement the plan of care. They should be evidence-based and tailored to the individual needs of the patient.
Actions the nurse will be doing to care for the patient. Examples might include medication administration, wound care, patient teaching, and emotional support.
Evaluation
Evaluation is the process of determining whether the interventions have been effective in achieving the desired outcomes. It involves reassessing the patient and comparing the current status to the expected outcomes.
Assessing if the interventions worked. This includes gathering data to determine the effectiveness of interventions.
If effective, continue the plan, and monitor the patient regularly. Positive outcomes reinforce the plan of care.
If not, revise the plan based on the evaluation data. This may involve modifying interventions, setting new goals, or addressing previously unidentified problems.
Nursing Process Simplified
Gather information (assessment): Collect comprehensive data about the patient's physical, psychological, social, and spiritual status.
Prioritize the patient's major issues: Determine the most pressing health problems based on the assessment data.
Create a plan to address these issues: Develop a nursing care plan with specific goals, outcomes, and interventions.
Implement the plan (interventions): Carry out the nursing interventions as outlined in the care plan.
Evaluate the effectiveness of the interventions: Assess the patient's response to the interventions and determine whether the goals and outcomes have been achieved.
HIPAA and Patient Confidentiality
HIPAA, the Health Insurance Portability and Accountability Act, is a federal law that protects patient privacy and the security of health information.
Information cannot be shared unless:
Direct care of the patient: Healthcare providers directly involved in the patient's care have a legitimate need to access the patient's health information.
Part of the interdisciplinary team (IDT): Members of the IDT, such as doctors, nurses, PT, dietary, social worker, etc., who collaborate to provide patient care, can share necessary information.
Violation consequences can include lawsuits, fines, and termination of employment.
Lawsuits: Patients can sue healthcare providers for violating their HIPAA rights.
Termination: Employees who violate HIPAA policies may be terminated from their jobs.
Example of HIPAA Violation
Joe Smith has a fish lodged in his urethra.
Nurse Sally shares this information with her boyfriend, who then shares it with others.
This is a HIPAA violation because the patient's protected health information was disclosed without consent.
The patient could be embarrassed and angry due to the breach of confidentiality.
Hypothetical Scenario
A girl is in a fatal car accident, and parents arrive asking about her.
If the patient is over 18, information cannot be disclosed without patient consent due to HIPAA regulations. The patient's right to privacy is paramount.
In emergencies where the patient is incapacitated, the priority is to save the patient's life. HIPAA regulations allow healthcare providers to disclose necessary information to family members or others involved in the patient's care, but these disclosures should be limited to what is necessary to address the emergency. Consequences should be assessed after attending to the emergency.
Nurses and Social Media
Nurses must not post private health information to social media. Doing so violates HIPAA and breaches patient confidentiality.
Example: A nurse was fired for going live while administering medication because she mentioned the patient’s name and the patient's diagnosis on social media. Even nurse Blake was talking about it.
Dignity and Respect
Patients need to be treated with dignity and respect during admissions, transfers, and discharges. This includes protecting their privacy, addressing them by their preferred name, and ensuring they are comfortable.
Example: Transferring a patient in a hospital gown with their butt exposed lacks dignity and violates their right to privacy. Such actions can cause embarrassment and emotional distress.
Respect During Patient Care
Making sure that the patients privacy is always covered in a gown or changing of the patient.
Being mindful of not having bystanders watch you when your caring for your patient.
Admissions Process
Admissions involve being admitted to a facility for care. This process sets the tone for the patient's entire stay.
The process starts before the patient arrives if it is a scheduled admission. Pre-admission planning helps to streamline the process and reduce patient anxiety.
Steps in Admissions
Patient signs consent forms and treatment forms. These forms provide legal permission for treatment and ensure that the patient is informed about their rights and responsibilities.
If on certain medications, they may need to sign additional consent forms due to the complexity of drug regimens. For this reason, it's imperative to make sure that they understand the potential complications and side effects.
The facility should have a smooth ride, not like a hotel that has no room ready. A well-coordinated admission process can alleviate patient anxiety and improve satisfaction.
Routine transitions can prevent anxiety. Standardized procedures help patients feel more secure and informed.
Call patient by their name to make it a more personal experience and lessen fear. Addressing patients by name shows respect and helps build a therapeutic relationship.
Required Forms
POLST (Physician Orders for Life-Sustaining Treatment): This form addresses CPR preferences and other end-of-life care decisions. It ensures that the patient's wishes are honored.
Must be signed by patient and doctor to be valid.
Informed consent forms for medications: These forms disclose potential complications and side effects, ensuring that the patient is fully informed before agreeing to treatment.
Must be signed by patient and doctor to ensure that the patient understands the risks and benefits of the medication.
Financial Aspects of Admissions
Hospitals ask for insurance information, not credit card deposits. Financial arrangements should be handled sensitively and transparently.
Types of insurance:
Private insurance: Coverage provided by private insurance companies.
Government-issued insurance (Medicare): Government-funded insurance for eligible individuals.
Example: a woman mentioned that she had gone to the hospital. She has insurance, and it cost her $3,000 for packing, one pill of medication and one spray of medication, that was given by the doctor.
Maslow's Hierarchy of Needs
Framework for understanding patient needs during admission. It provides a useful framework for prioritizing nursing interventions and promoting patient well-being.
Levels:
Physiological needs (basic needs): These include oxygen, food, water, and shelter. Addressing these needs is essential for survival.
Safety needs (security): This includes physical and emotional security. Patients need to feel safe and protected in their environment.
Love and belonging: This includes feeling connected to others and having meaningful relationships. Social support is crucial for emotional well-being.
Esteem: This includes feeling good about oneself and having confidence in one's abilities. Positive self-esteem promotes resilience and coping.
Self-actualization: This includes reaching one's full potential and living a meaningful life. Supporting patients in achieving their goals promotes a sense of purpose and fulfillment.
Patient Reactions to Hospitalization
Patients may face anxiety and worries when getting admitted.
Kids will face the separation anxiety when facing an admission.
Older adults have a tendency to be depressed.
Loss of Identity
Feeling a loss of self-identity affects self-esteem on Maslow's hierarchy. Hospitalization can strip patients of their sense of self and independence.
Losing independence for an older individual will make them feel like they are losing their independence. Maintaining independence is crucial for older adults' well-being.
This makes them feel like they are not home and that you can’t take care of yourself. Creating a homelike environment can help patients feel more comfortable.
This takes away feeling of self-esteem. Empowering patients to make decisions about their care can boost their self-esteem.
Nursing Interventions
Actions to improve the patient's experience. Creating a positive patient experience can improve outcomes and satisfaction.
Showing empathy. Empathy involves understanding and sharing the feelings of others. It is essential for building trust and rapport.
Compartmentalizing personal issues: Setting aside personal problems to focus on the patient's needs.
Focusing on the patient's needs: Prioritizing the patient's comfort and well-being.
Being caring and showing warmth. Demonstrating compassion and concern for the patient.
Smiling and demonstrating empathy.
Treating patients with dignity and respect.
Adjusting hospital routine to meet patient needs and desires as possible.
Example: Adjusting their daily schedule with religious accommodations.
Cultural Considerations
Being aware of diverse cultures and languages. Cultural competence is essential for providing patient-centered care.
Using language as a bridge to connect with patients. Effective communication is key to understanding the patient's needs and preferences.
Important because the diversity makes this a training ground to respect them.
Making the patient feel more comfortable and knowing when to get an interpreter.
There are conversation Spanish and medical Spanish when speaking to the patient.
Respect for Patients
Call patients Mr., Miss, or Mrs unless they specify otherwise. Use titles of respect to show courtesy and professionalism.
Avoid speaking a different language with colleagues in front of patients to avoid misunderstandings and maintain transparency.
When you speak another languages you may encounter patients who will be of the same ethnicity, but that does not mean that you automatically start speaking to them in your language. Always ask for your patient’s preference before assuming what they are most comfortable with.
Cultural and Religious Beliefs
Certain religious requests are required to have bed face a certain direction or may require prayer rags available.
Being aware of cultural beliefs
Example: A patient believe that leaves have mystical power in healing, then okay.
A nurse may want to know how you feel and what you feel about Haitian.
In ATI, the nurses are more authority over the doctor because they have more interactions than they do with the patient’s.
There are families that prefer to make decisions as a whole.
They associate wheelchairs with being sick.
Overview from Videos
Admission process involves:
A ward nurse accepting the patient.
Showing the patient to their bed.
Traffic light assessment.
Explaining the ward routine.
Daily check-ins from junior doctors.