Supported Practice Learning ExperienceHospital NURS09069Word Count: 1551September 2008 CohortSafe effective Discharge PlanningReflection is an important part of ensuring the care provided is being continually evaluated and improved (Lillyman & Ghaye, 2002). Lillyman and Ghaye (2000)also state that reflection can show us how to influence practice and colleagues, within health and social care collaboration is needed as no one profession alone can meet all of a patient??™s needs (Irvine et al. 2002). The Healthcare Quality Stategy for NHS Scotland was published in 2010; its aim was to provide effective patient centred care (Healthcare Quality Strategy for NHS Scotland, 2010). All patient discharges require the nurse to work in collaboration with the interprofessional health and social care team, with the patient and any carers whether this be formal or informal (Farquhar et al. 2005).
For this reflection which is based on a safe patient discharge from hospital, I have chosen the Gibbs reflective cycle approach to give structure to my reflection. This reflective model helps to produce a clear description, analysis of feelings, evaluation and an overall conclusion of the event (Gibbs, 1998).Description of the Event
During my seven week acute practice placement within the hospital my interest in safe effective discharge planning was aroused after one of my patients that had been admitted in my first week of placement was discharged and readmitted another two times before I had finished. For the purpose of this assignment I shall name my patient Mr Smith, this is to ensure my patients privacy and confidentiality is adhered to (NMC, 2008). The NMC 2008 outlines the right to patient confidentiality and I have a duty to adhere to it. The first time my patient was being discharged home i felt that he was being sent home without appropriate support, but even as a 3rd year student I felt i had to be cautious on expressing my opinions on what I thought about the patients discharge because it was my first week and I was just learning the wards routine. By the last admission, as I was a 3rd year student my mentor had allocated me my set of patients at the start of each shift, Mr Smith was allocated to me. I carried out all care on all my allocated patients as well as contributing to ward and social rounds. During his last admission Mr Smith was made homeless but no one on the ward seemed concerned by this, however this wasn??™t due to neglect of his social and future needs, he became very withdrawn a few days before discharge and appeared worried and concerned. I spoke to him as I was worried from the way he was acting, the situation soon became apparent and as he was set for discharge, I advised my mentor right away, here I felt I had the duty to act as my patients advocate, adhering to my NMC Code of Conduct . In turn my mentor advised me that she felt I was more than capable of handling the situation. Therefore I contacted Mr Smith??™s social worker as he didn??™t have any close family to look after him or that visited him whilst in hospital. I was aware at the same time that whilst arranging accommodation for my patients discharge was fundamentally important to his wellbeing arranging all this even as a 3rd year student was beyond the scope of my practice therefore I also required the help of other health and social care professionals. Therefore I adhered to my code of conduct by taking responsibility for my actions by knowing my own limitations in this situation and seeked assistance from the appropriate members of the multidisciplinary team (NMC, 2010). Without the help and guidance from my mentor and other members of the multidisciplinary team my patient would not have been discharged safely.Feelings ??“ What were the feeling of you and others in the situation
I feel I coped with the situation appropriately. Ensuring all concerns and paperwork were reported and countersigned by my mentor. I felt more empowered and in charge and never felt under pressure that I could not deal with this discharge safely and effectively. Although, in the beginning I did doubt myself on how to handle the situation, however after speaking to my mentor who gave me the encouragement I needed, I got my confidence back and dealt with this situation professionally. Once it had been completed and my patient was discharge safely I felt a sense of gratification that I had achieved the goal which I set, to discharge my patient safely and effectively back into the community.Evaluation ??“ What was good & bad about the experience
I felt the experience was a positive and significant one, due to the nature of the patient??™s discharge. It wasn??™t a regular discharge therefore needed a lot more input from the individuals involved in this patients care. I feel it was a challenge for me to show how I can cope with unusual situations which don??™t occur that often. Even though I took longer to manage the situation that a regular staff nurse would my mentor was not concerned, she was pleased that I took my time and handled the situation with safely to ensure all patients future needs were met before discharge. Therefore I ensured as a 3rd year student I took responsibility on the care given to my patient adhering to my NMC Code of Conduct as it states ???that all nurses are accountable for their practice??™. Ensuring all my paperwork was counter signed and discussed before taking actions ensured all my care given was safe and accurate.Analysis ??“ What sense can you make of the situation
Effective evidence based care is a duty of the nurse and is a requirement of the Nursing and Midwifery Council (NMC, 2008). The code tells us we must ???deliver care based on the best available evidence or best practice??™ (NMC, 2008). Overcoming the barrier??™s, actual or perceived, is important in providing the highest quality of care to our patient??™s. In order to properly implement evidence based practice we need to take into account the triad of sound evidence base, patient preference where practicable and the experience and expertise of the health care professionals involved (Hek & Moule, 2006). Therefore, to ensure a patient is transferred from any health care setting to home involves interprofessional collaboration which requires competence, good decision making and prioritisation of all professionals involved (Henwood, 2006). The Planned Care Improvement Programme is a Scottish Government Paper published in 2007 which concentrates of the flow of a patient through planned care. The paper highlights the benefits in smooth plan care, helped by starting the discharge as early as possible which in turn reduce the risk of infections, the reduction in re-admissions or shorter length stays.Conclusion
Overall, although discharge planning is seen as an uninteresting aspect of the nurses role (Lees & Emmerson, 2006), It is important that the nurse fully knows their patient from admission through to discharge and therefore allows them to plan truly individualised care (Radwin, 1996), they are the best at keeping the patient informed, therefore they can manage discharge safely and effectively to ensure the patients??™ future needs are not compromised and they receive the long term support needed to avoid future re-admissions.Action Plan ??“ What has been learnt and what will I apply to future practice
This situation has shown me how competent as a 3rd year student. I have learned that not all discharges from hospital are a smooth process and can be complex depending on the future needs of the patient. I have learned that excellent communication skills and working within a team is very important in providing a smooth transition from one environment to another. Therefore, considering the Healthcare Quality Stategy , my role would be to improve the quality of care given to my patients by ensuring I provide them with the best possible care, by learning from my experience I will continue to develop my skills in order to have more confidence in myself and have excellent communication skills in order to provide this.References * Furqhar M. C., Barclay S. I. G., Earl H., Grande G. F., Emery J. & Crawford R. A. F. (2005) Barriers to effective communication across the primary and secondary interface: exaples from the ovarian cancer patient journey (a qualitative study) European Journal of Cancer Care 14 p359-366
* Gibbs G. (1998) Learning by doing. A guide to teaching and learning methods, Oxford: Oxford Books University
* Hek G. & Moule P. (2006) Making Sense of Research. London: SAGE
* Henwood M. (2006) Effective partnership working: a case study of hospital discharge. Health and Social Care in the Community 14 (5) p 400-407
* Irvine R., Kerridge I. & McPhee J. (2002) Interprofessionalism and Ethics: consensus or clash of cultures Journal of interprofessional care 16 (3) p199-210
* Lees L. & Eerson K. (2000) Identifying discharge practice training needs, Nursing Standard 20 (29) p47-51
* Lillyman S. & Ghaye T. (2000) Caring Moments: The disclosure of reflective practice, Dinton: Mark Allen
* Nursing and Midwifery Council (2010), The Code: Standards of conduct, performance and ethics for nurses and midwives: London
* Radwin L. E. (1996) ??? Knowing the patient ???a review of research on an emerging concept??™, Journal of advanced nursing 23 (6) p1142-1146
* www.nhsggc.org.uk

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