Hospital Discharge Planning: A Critical Review

This assignment critically reviews the effectiveness of hospital discharge planning. It delves into the challenges associated with ensuring successful transitions from hospital to home for patients, particularly focusing on communication barriers, patient understanding, and the impact of cultural factors. The review analyzes various strategies and interventions aimed at improving discharge planning outcomes, drawing upon relevant research studies and clinical guidelines.

Running head: NURSING CASE STUDY
Discharge plan for a patient
Name of the Student
Name of the University
Author Note

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Executive summary
Discharge planning acts as the quality link between community-based services, hospitals, carers
and non-government organizations. Amid huge advances in healthcare, that include reduction in
hospital stays, it is essential to realize the potential of discharge practices on patient health
outcomes, wellbeing and quality of life. It enables patients to return to their home and
community setting after an in-patient episode. The following report will discuss the discharge
planning of a patient Jim Karas, who was admitted to the hospital after prolonged exposure to
carbon monoxide fumes inside his car. The report will outline the precepts that are required in
the discharge process. The care plan will ensure that community-based services are integrated to
improve the health status of both the patient and his dependent wife.

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Table of Contents
Introduction......................................................................................................................................3
Discussion........................................................................................................................................3
Course of action for discharge.....................................................................................................3
Legal and Ethical principles........................................................................................................6
Conclusion.......................................................................................................................................8
References........................................................................................................................................9

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Introduction
Care transfer or discharge of patients forms an essential part of healthcare management in
any hospital or aged care setting. Discharge planning ensures that the social care and health
systems are working in a proactive fashion to support the concerned individual and his family
members or carers to either get transferred to another healthcare setting or safely return home
(Watkins, Hall & Kring 2012, p.120). Any visit to a hospital or aged care centre is intimidating
for the concerned patients and their families. The role of a caregiver is to completely focus on the
medical treatment during admission and formulate a care plan according to the events that might
happen when the patient leaves the hospital (Shepperd et al. 2013). This report will elaborate on
a discharge care plan for a patient Jim Karas and will further illustrate the ethical and legal
principles that must be taken care of during healthcare decision making.
Discussion
Course of action for discharge
Hospital discharge post admission is one of the most dangerous transitions for patients.
Discharge of a patient from hospital to home needs a successful information transfer to the
patient as well as their family. This reduces readmissions and adverse events (Bar-Zeev et al.
2012, p.370). I have been assigned the responsibility to discharge the patient Jim Karas in a
timely manner and with utmost priority.
The way of handling this transition during discharge to home or any other rehabilitation
facility is critical to the wellbeing and health of the concerned individual. Results from several

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studies indicate that improvement in hospital discharge plans dramatically improve patient
outcomes during transition (Gonçalves‐Bradley et al. 2016).
Patients, family caregivers, and healthcare providers all play roles in maintaining a
patient’s health after discharge. The patient Jim was admitted to the hospital after a prolonged
exposure to carbon monoxide inside his car. The physician has approved his discharge from the
hospital after several interventions. The discharge plan I intend to produce will include:
Adequate evaluation of Jim Karas to determine the appropriateness of his discharge
Determination of the optimal care resources that can be accessed by him as well as his wife
Determination that his financial resources are adequate to afford the care resources for a better living
My discharge plan will include steps that need to be followed by Jim to avoid
complications due to carbon monoxide poisoning. I will try to make them abide by instructions
to delay any complications because there is a high tendency of occurrence of risk factors for
problems after discharge. The discharge instructions will be formed to avoid incidence of any
anomalities in the brain that can lead to coma or even death (Hansen et al. 2013, p.425). I will
warn Jim as well as his daughter Angela about the delayed neurological symptoms that can occur
following his discharge from the hospital. DNA or delayed neurological sequealae can occur due
to exposure to carbon monoxide. I will formulate a self care plan and will advise Jim’s daughter
to assist him while practicing the plan. This self care plan will include:
Breathing exercises

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Breathe out with puckered or pursed lip.
Breathe using the diaphragm. One hand should be placed on the abdomen while breathing in.
This will make the hands to move upwards or outwards. Thus, the lungs will get more room to
enlarge in volume and more air will be subsequently drawn in.
Abstaining from smoking and alcohol
Smoking and alcohol will worsen your condition.
Follow-up
Angela should accompany her father for a follow-up to the hospital after 2 weeks.
Call for the emergency service
The emergency service should be immediately called for, if Angela notices that her father is
facing difficulty in breathing or complains of a chest hurt or feels dizzy and is unable to stand.
My discharge planning will also try to promote the use of services in their locality that
will improve the overall wellbeing of Jim and his wife Amara. Awareness of women health
issues is poor in Greek culture (Morton et al. 2017). In order to avoid culture clashes and
misunderstanding, I will try to implement successful transfer of information to the daughter
Angela, who is proficient in English. I will describe what the life at home would look like after
Jim is released from the hospital and would educate her about the patient condition. Limited
English proficiency will prevent Amara from showing adherence to services that will cure her
depressive disorder (Altfeld et al. 2012, p.437). Therefore, my discharge plan would suggest
consultation with a professional interpreter at the service centres to meet the cultural needs

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(Karliner et al. 2012). Greek family values have strong elements of culture and tradition that
transcends across generations. The services will therefore re-establish family connections.
Enrolment at Uniting Agewell Aldersgate Community services
Since, Amara was completely dependent on Jim owing to her chronic COPD and depressive
condition; Jim’s present health status will not permit him to provide her assistance.
They will be encouraged to visit the residential service in Launceston that will provide a warm
and welcoming environment.
Their individual needs will be recognised and a sense of choice, wellbeing and
independence will be built. This will reduce her dependence on her husband (Denson,
Winefield & Beilby 2013, p.9). Utilise palliative care support from the trained staff.
Use ACAT assessments
Before moving to an aged-care centre, Angela should take her parents for a free consultation by
an Aged Care Assessment Team in her locality. The members of the team will talk to Jim and
Amara about their current situation and will figure out if they are eligible to receive aged-care
services at subsidised rates.
The approval will help to determine if they need respite care in the aged-care home.
Consulting psychotherapists for counselling Jim
This will help Jim to get rid of the mental stress that is created due to financial burden and
money worries. Moreover, the mental trauma he experiences due to family issues and his wife’s
physical ailments will be greatly reduced by using this service.

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Legal and Ethical principles
Ethically speaking, patient-care situation forms the heart of practice dilemmas that are
faced by nurses. Dilemmas related to ethical issues of scant resource distribution occur
frequently within hospital settings. The ethical principle of justice is responsible for guiding
equal treatment for all patients; yet, limited financial and organizational consequences pose
difficulties. Decision making can be used to address ethical dilemmas. Adherence to principles
of beneficence and autonomy are fundamental to the process. The patient should be given the
right to make decisions regarding his treatment, regardless of medical recommendations (Barry
& Edgman-Levitan 2012, p.780). A competent patient with sound mind should be allowed to
take healthcare decisions, including non-compliance. Thus, the process enhances patient
engagement. The laws direct nurses to advocate and fight for patient rights. Shared decision
making is patient specific and relies on medical evidence, clinical expertise and cultural factors.
Working as a patient advocate helps the nurses to support patient wishes even when it goes
against the decisions of the family or physician. Shared decision making also provides a
mechanism to translate comparative effectiveness research outcomes, supported by policies, into
clinical decisions (Légaré & Thompson-Leduc 2014, p.285).
While applying ethical and legal principles, it is necessary to determine the potential
harm or benefits of the proposed treatment and discharge plan. Research evidence indicates that
strong communication skills of a healthcare staff facilitate the patient’s capacity to show
compliance to medical recommendations and self-management (King et al. 2013, p.1100). A
patient perception of healthcare quality depends on their interactions with clinicians and nurses.
Effective communication promotes diagnostic accuracy, adherence to treatment, patient safety
and satisfaction. According to the Administration of Hospital Admissions and Discharge Policy,

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a patient is considered safe to be discharged when the hospital ceases responsibility for his care
and separates him from hospital accommodation (Veroff, Marr & Wennberg 2013, p.119).
Another problem that can arise is Discharge against medical advice (DAMA). It occurs when the
patient decides to leave the hospital against his physician’s opinion. This is generally advocated
by the patient themselves or by their relatives or parents. DAMA is considered a problematic
issue for all healthcare staff due to the interruption of patient interaction and often leads to
adverse health outcomes. The associated healthcare costs increase (Durocher et al. 2015, p.297).
Conclusion
Thus, it can be concluded that efficient discharge planning caters to the demands of a
patient for a smooth transition from hospital to home. It decreases rates of hospital readmissions
and works towards providing holistic care to the patient. I would try to become familiar with all
aspects of the patient’s situation and will try the best possible means to enhance my care-giving
capabilities. The proposed discharge plan would include coordination between the patient
experiences and the services, elimination of language barriers, close monitoring of activities that
can increase harmful effects of carbon-monoxide poisoning and usage of services that will
enhance financial, cultural, social and mental wellbeing of the family in their some setup.

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References
Altfeld, SJ, Shier, GE, Rooney, M, Johnson, TJ, Golden, RL, Karavolos, K, Avery, E, N&i, V &
Perry, AJ 2012, ‘Effects of an enhanced discharge planning intervention for hospitalized older
adults: a r&omized trial’, The Gerontologist, vol. 53, no. 3, pp. 430-440.
Barry, MJ & Edgman-Levitan, S 2012, ‘Shareddecision making—the pinnacle of patient-
centered care’, New Engl& Journal of Medicine, vol. 366, no. 9, pp. 780-781.
Bar-Zeev, SJ, Barclay, L, Farrington, C & Kildea, S 2012, ‘From hospital to home: the quality &
safety of a postnatal discharge system used for remote dwelling Aboriginal mothers & infants in
the top end of Australia’, Midwifery, vol. 28, no. 3, pp. 366-373.
Denson, LA, Winefield, HR. & Beilby, JJ 2013, ‘Discharge‐planning for long‐term care needs:
the values & priorities of older people, their younger relatives & health
professionals’, Sc&inavian journal of caring sciences, vol. 27, no. 1, pp. 3-12.
Durocher, E, Kinsella, EA, Ells, C & Hunt, M 2015, ‘Contradictions in client-centred discharge
planning: Through the lens of relational autonomy’, Sc&inavian journal of occupational
therapy, vol. 22, no. 4, pp. 293-301.
Gonçalves‐Bradley, DC, Lannin, NA, Clemson, LM, Cameron, ID. & Shepperd, S 2016,
‘Discharge planning from hospital’, The Cochrane Library.
Hansen, LO, Greenwald, JL, Budnitz, T, Howell, E, Halasyamani, L, Maynard, G, Vidyarthi, A,
Coleman, EA. & Williams, MV 2013, ‘Project BOOST: effectiveness of a multihospital effort to
reduce rehospitalization’, Journal of hospital medicine, vol. 8, no. 8, pp. 421-427.

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Karliner, LS, Auerbach, A, Nápoles, A, Schillinger, D, Nickleach, D & Pérez-Stable, EJ 2012,
‘Language barriers and understanding of hospital discharge instructions’, Medical care, vol. 50,
no. 4, p. 283.
King, BJ, Gilmore‐Bykovskyi, AL, Roil&, RA, Polnaszek, BE, Bowers, BJ. & Kind, AJ 2013,
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Légaré, F. & Thompson-Leduc, P 2014, ‘Twelve myths about shared decision making’, Patient
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Morton, PG, Fontaine, D, Hudak, CM. & Gallo, BM 2017, ‘Critical care nursing: a holistic
approach’, Lippincott Williams & Wilkins.
Shepperd, S, Lannin, NA, Clemson, LM, McCluskey, A, Cameron, ID. & Barras, SL 2013,
‘Discharge planning from hospital to home’, Cochrane Database Syst Rev, vol. 1, no. 1.
Veroff, D, Marr, A. & Wennberg, DE 2013, ‘Enhanced support for shared decision making
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