https://padlet.com/jmarcella/k35e4bgnucl0 en-us 2017-04-21 18:30:34 UTC 2024-07-31 02:43:16 UTC hello@padlet.com https://padlet-assets.s3.amazonaws.com/icons/Hearts.png jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167566826            By Jermaine Marcella]]> 2017-04-21 18:36:14 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167566826 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167568913 2017-04-21 18:46:22 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167568913 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569036 What is the nurse doing or not doing in relation to the issue? 

• To maximize the number patients seen in the ED, discharge instructions may be “truncated” or “delivered in as little as 2 minutes and often without assessing patient comprehension” (Limpahan, Baier, Gravenstein, Liebman, & Gardner, 2013, p. 1300)
  • Exacerbates the problem by providing inadequate discharge teaching
  • Indicates the need for more training in providing proper discharge teaching 
• Printed "diagnosis-specific discharge instructions" (Boonyasi et al., 2014) -- gives nurses guidelines for discharge teaching and patients a reference
  • Inconsistently reinforced with verbal instructions
• New ED patient flow system -- increase efficiency in the ED
  • Require more nursing staff -- without enough staff, there is more pressure on the nurses to quickly discharge patients
  • Internal waiting rooms -- not optimal for delivering discharge education (Marino, Mays, & Thompson, 2015)

]]> 2017-04-21 18:46:57 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569036 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569703 Explain why the nurse’s involvement is important:

• Nurses are the last healthcare team member the patient sees in the ED. They provide the patient with their discharge papers and instructions.

How would the nurse be able to help resolve or improve the selected issue?

• Provide "protected time" -- ED nurses could set aside uninterrupted time in a quiet, distraction-free environment in order to optimize patient learning (Samuels-Kalow et al., 2015, p. 285)
• Perform follow-up telephone calls or emails -- allow nurses opportunity to clarify discharge instructions
  • Increase compliance with discharge instructions and adherence to follow-up appointments (Boonyasi et al., 2014)
• Perform teach-back: nurses are able to assess patient comprehension
  • Teach-back also helps in retention of information (Griffrey et al., 2015)

]]> 2017-04-21 18:49:58 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569703 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569812 Challenges or barriers for nurse involvement: 

• Environment -- ED nurses are sometimes forced to perform discharge teaching in hallways or internal waiting rooms
  • Added task at finding a suitable place
• Limited staffing -- nurses are not able to provide the adequate time needed 
  • Increased staffing, may result in increased the financial burden within the unit
• The Centers for Medicare and Medicaid Services support "compliance measures" for discharge instructions of admitted patients but does not specifically address ED discharge (Atzema et al., 2013, p. 2)

If the nurse is not participating, or the participation is limited, explain why.

• Sensitization -- nurses no longer see the importance and value in discharge education
• Literature focused on increased provider participation and use of technology to amend nursing participation

]]> 2017-04-21 18:50:31 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569812 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569904

Inservice or further training: ED nurses should be reminded of the importance of discharge teaching and the proper way to discharge a patient 

Build a team: a team of nurses should be set to handle this particular issue.  This team could assess nursing compliance on discharge education and address problems that may arise. 

• Helps the nurses take a more proactive approach in solving this issue

Provide incentives: nurses who provide thorough discharge instructions as evidenced by their documentation or patient-survey should be recognized

• Shows that the whole unit supports the nurse's effort to provide thorough discharge education

]]> 2017-04-21 18:50:56 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167569904 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167570012 NUR 315 taught me two fundamental concepts that I can apply to this issue:

1. Nurses are trained not only to act and think but also to educate.
2. Nurses have a legal and ethical responsibility to protect their patient's privacy.

]]> 2017-04-21 18:51:21 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167570012 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/167570191

87% of patients who come to the Emergency Department (ED) are discharged back to their residence (Atzema et al., 2013). 

Patients who are discharged to home have only their discharge instructions to help them manage their health at home. 

The fast-paced and, often, overcrowded environment of the ED creates challenges for nurses to deliver adequate discharge instructions.

Inadequate discharge teaching leads to "worse health outcomes, including increased ED visits" and hospitalizations (Samuels-Kalow et al., 2015).

]]> 2017-04-21 18:52:06 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/167570191 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978023 2017-04-28 20:40:20 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978023 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978375 2017-04-28 20:44:29 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978375 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978445 2017-04-28 20:45:15 UTC https://padlet.com/jmarcella/k35e4bgnucl0/wish/168978445 jmarcella https://padlet.com/jmarcella/k35e4bgnucl0/wish/169231983

ANA code of ethics:

• Provision 1 -- nurse's primary commitment is to the patient (Winland-Brown, Lachman, & Swanson, 2015)
• Provision 2 -- we must advocate for and protect the rights, healthy and safety of the patient (Winland-Brown, Lachman, & Swanson, 2015)

Providing adequate discharge teaching is part of a nurse's commitment to the patient.

Nurses must advocate for the right of the patient to be adequately informed of their condition and treatment plan for their safety.

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