NGR 5110 FIU Qualitative Research Project Phase Four Paper

Running Head: OBSTACLES TO EFFECTIVE DISCHARGE PLANNINGFactors that Limit Effective Discharge Planning for Chronically ill Patients in ICU
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 02/302020
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Table of Contents
Introduction ……………………………………………………………………………………………………………….. 3
Statement of the Problem …………………………………………………………………………………………….. 4
Purpose of the Study …………………………………………………………………………………………………… 4
Approach …………………………………………………………………………………………………………………… 4
Research Question ……………………………………………………………………………………………………… 5
Expected Outcomes ……………………………………………………………………………………………………. 5
Significance of the Study …………………………………………………………………………………………….. 5
Methodology ……………………………………………………………………………………………………………… 6
Research Design……………………………………………………………………………………………………… 6
Sample Population and Sampling Method ………………………………………………………………….. 6
Data Collection ………………………………………………………………………………………………………. 6
Data Analysis …………………………………………………………………………………………………………. 6
References …………………………………………………………………………………………………………………. 8
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Introduction
According to Naylor et al. (2011), the goal of transitional care is to prevent
hospitalizations and health complications of chronically ill patients when they leave hospital
settings. It is a process that requires a comprehensive home-follow-up and discharge
planning. Effective discharge planning is meant to link the treatment that a patient receives at
the hospital and the post-discharge care that the patient receives from the community
(Shepperd et al., 2013). When patients arrive at the hospital, nurses should: i)
comprehensively assess the health status of the patient, ii) develop comprehensive care plans
for every patient using evidence-based guidelines, and in collaboration with other health
professionals and the families of the patients, and iii) daily visit and asses the patient and start
working on a care plan upon discharge. When a patient gets discharged from the hospital, a
nurse should visit the patient periodically at home or schedule phone calls with the patient.
Numerous studies such as Behzadian and Kapelan (2015), Mazloum et al. (2016), and
Kisely et al. (2017) .indicate that patient satisfaction and health outcomes increase with
effective discharge planning, while other studies indicate that it reduces readmission rates and
the length of stay at the hospital. Discharge nursing is an essential component in nursing
because it has significant impacts on how the family copes when chronically ill patients leave
the hospital. Discharge planning follows the following steps: i) identifying patients that will
need help with discharge planning, ii) working together with the patient’s family and other
healthcare professionals in planning the discharge, iii) recommending continued care options,
or referring the patient to services or programs that meet their preferences and needs, and iv)
encouraging and supporting the patients and their families during the care periods. But
despite the importance of discharge planning, Wong et al. (2011) argues that most hospitals
discharge their patients without proper panning. This research will explore the experiences
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
that nurses face during discharge planning with the aim of identifying the obstacles to
effective and comprehensive discharge planning.
Statement of the Problem
Many studies have revealed that most hospitals discharge their patients with
inadequate information, poor instruction, poor communication, insufficient planning, and
poor coordination between and among healthcare teams. Whenever discharging patients,
hospitals should ensure that comprehensive discharge plans are developed for each and every
patient, depending on the uniqueness of their cases (Raven et al., (2011). And since nurses
are always in contact with the patients and their families, they have a role to play in ensuring
that each patient and a comprehensive discharge plan before leaving the hospital. But as
many studies indicate, most healthcare providers do not release their patients from hospitals
with comprehensive discharge plans.
Purpose of the Study
The purpose of the study will be to explore the factors that hinder nurses’ ability to
develop comprehensive discharge plans for chronically ill patients effectively. The researcher
hopes that the findings of the study will be used by nurses and other health professionals in
overcoming the challenges to effective discharge planning of patients in ICU.
Approach
The researcher will approach the research both bibliographically and empirically.
Bibliographic research will involve a review of the literature on similar topics in order to
understand the investigations of other experts as contained in the relevant literature.
Empirical research will allow the researcher to challenge, extend, and verify the hypothesis.
Empirical research will involve the collection of data from selected participants; collected
data will then be analyzed and conclusions made.
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Research Question
This study will aim at answering the following research question:
1. What are the Factors that Limit Effective Discharge Planning for Chronically ill
Patients in ICU
Expected Outcomes
Through this research, the research expects to gain insight and identify the factors that
hinder nurses’ abilities to develop an effective discharge plan for chronically ill patients in
ICU. The researcher will explore the experiences and views of different nurses and hopes that
the participants will help identify those factors and how they can be controlled. The
researcher envisions that the findings of the research will be used as the basis for
improvements in regard to patient discharge planning, thus relaxing heightened anxiety levels
of families related to their patients being discharged from hospital. Evidence-based discharge
planning could also be used to manage time and to improve job satisfaction on nurses
working in ICU.
Significance of the Study
With the right information, healthcare professions – nurses included – can be able to
develop comprehensive discharge plans tailored towards the needs of individual patients. It is
expected that this research will reveal the factors that hinder effective discharge planning and
propose strategies that can be employed by a health professional in overcoming those
obstacles. If nurses and other health professions can arm themselves with the right
information, skills, and attitude, their efficiency also increases, eventually translating to
increased health outcomes and satisfied patients.
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Methodology
Research Design
The findings of this study will be based on the views of nurses in ICU, and on
information obtained from relevant literature reviews. Therefore, the researcher will use a
qualitative design because of its suitability in exploring the behaviors and thoughts of people
individually and when in groups.
Sample Population and Sampling Method
The participants in this study will be 15 INC nurses within the XYZ area. A small
sample population will be chosen for this study due to time and financial constraints.
Purposive sampling will be used in selecting participants because it is the only way the
researcher will be sure that the chosen participants (nurses) have knowledge of the topic
under investigation (Etikan et. al., 2016). Only registered nurses with at least two years of
experience will be used in the study. Student nurses of nurses with less than two years of
experience will be excluded.
Data Collection
The researcher will collect data using in-depth interviews, which will be guided by
prompts and opening questions from the researcher. This will allow the researcher to develop
his own views. As opposed to structured questions, Prompts prevent the research from
forcing participants into certain lines of thought; they allow participants to speak of their
experiences using their own words (Pietkiewicz et al., 2014).
Data Analysis
Thematic content analysis will be used because it will allow the researcher to identify
main elements and recurring themes from collected data. Recorded interviews will first be
transcribed by the researcher. Transcription is a time-consuming exercise, but it will allow
the researcher to be immersed in the collected data. Transcribed data will be stored
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
electronically as word documents, followed by transcripts coding. To maintain the anonymity
of participants, pseudonyms will be used instead of their names. The researcher will then
analyze the data using SPSS and then summaries and conclusions made. To guarantee the
authenticity of the findings, an independent researcher will be asked to review the data and
validate it.
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
References
Behzadian, K., & Kapelan, Z. (2015). Advantages of integrated and sustainability-based
assessment for metabolism based strategic planning of urban water systems. Science
of the total environment, 527, 220-231.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Kisely, S., Wyder, M., Dietrich, J., Robinson, G., Siskind, D., & Crompton, D. (2017).
Motivational aftercare planning to better care: applying the principles of advanced
directives and motivational interviewing to discharge planning for people with mental
illness. International journal of mental health nursing, 26(1), 41-48.
Mazloum, S. R., Heidari-Gorji, M. A., Bidgoli-Gholkhatmi, M., & Agayei, N. (2016).
Effectiveness of discharge-planning on physical quality of life of patients with
ischemic heart disease. International Journal of Applied and Basic Medical Research,
6(2), 129.
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The
importance of transitional care in achieving health reform. Health affairs, 30(4), 746754.
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative
phenomenological analysis in qualitative research psychology. Psychological journal,
20(1), 7-14.
Raven, M. C., Doran, K. M., Kostrowski, S., Gillespie, C. C., & Elbel, B. D. (2011). An
intervention to improve care and reduce costs for high-risk patients with frequent
hospital admissions: a pilot study. BMC health services research, 11(1), 270.
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OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L.
(2013). Discharge planning from hospital to home. Cochrane database of systematic
reviews, (1).
Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C., Chan, F. W., Wong, F. Y., & Yeoh,
E. K. (2011). Barriers to effective discharge planning: a qualitative study investigating
the perspectives of frontline healthcare professionals. BMC health services research,
11(1), 242.
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Running head: IMPLEMENTATION PHASE
Implementation Phase
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 03/05/2020
1
IMPLEMENTATION PHASE
2
Implementation Phase
Implementation of effective discharge planning depends on the payment, finance
regulation, and the behavior of the service providers, policymakers, and the service recipient
(Miller, 2013). Health care facilities should always ensure that there is an effective discharge
planning process. Implementation of effective discharge planning follows the procedure of
assessing current patient needs, providing appropriate continued care needs, and recognizing
the resources that are available to meet care needs after the hospital.
Effective Discharge Planning Process
The first step of the effective discharge planning process is to include the patient
together with family members in the entire process (Nordmark et al., 2016). Engaging the
patient and the family is essential as the discharge is a process that takes place throughout the
patient’s hospital stay. It helps to identify the caregivers to be after the discharge of the
patient.
The second step of the effective discharge planning process is discussing with the
patient and family members the critical areas required for home care. These vital areas
include describing the home environment, the support that will be necessary, and what the
patient can and cannot eat. Another critical area is the reviewing of the medications (Miller,
2013). Warning signs and problems should also be marked. It will also be essential to explain
the test results to the patients and the family in case the results are available. In the cases
where the results are not available, the patient and the family members should be told on
when to wait for the results.
The third step of effective discharge planning is educating the patient and the family
about the condition of the patient, the process of the discharge, and the next discharge step
IMPLEMENTATION PHASE
3
throughout the hospital stay. The purpose of doing this is to help familiarize and increase the
confidence of those to become caregivers (Miller, 2013).
The fourth step of effective discharge planning is the assessment of how well the
nurses and the doctors explain the diagnosis and the next steps to the patient and the family
(Miller, 2013). Here, the patient and the family are provided with information in bits. The
patient and the family members are allowed to repeat this information to ensure that they
understand. The final step is listening to the family and the patient’s goals, preferences, and
concerns.
Implementation of an effective discharge planning process
Step 1: Forming a team to identify areas that need improvement
The group formed should be composed of nurses, management staff, hospital staff,
family representatives of the patient, and the patient (Nordmark & Lindberg). The patient and
the family contribute to the achievement of the effective discharge planning process. They
also provide feedback on what discharge planning process feels like as a patient and the
family members. Furthermore, the patient and the family members observe the nurse and the
hospital staff in determining whether they meet the elements of an ideal discharge planning
process.
Assessment of the visitation policies of the family should be done.
This will ensure that the family members are ever-present throughout the entire
process. If possible, the visitation policy should not just entail the visiting hours, but the
family members should always be allowed to be with their patients (Miller, 2013).
Assess the current view on the effective discharge planning process.
IMPLEMENTATION PHASE
•
4
Determine the steps taken for the effective discharge planning process. This checks on
how the nurses coordinate their interactions with the patient and the family (Naylor et
al., 2011). It also checks on whether those involved in the effective discharge
planning process are satisfied or not.
•
Determine the strengths of the effective discharge planning process. This checks if the
patient and the family members understand all the steps in their care (Naylor et al.,
2011). To determine the factors that encourages the patient and family engagement in
the discharge planning strategy.
•
Check on the areas that need improvement and the possible challenges in the
implementation of the effective discharge planning process.
Asses the challenges faced in changing of the staff behavior
The effective discharge planning process may require hospital staff, nurses, members
of the family, and the patient to adopt a new behavior. However, this may face the following
challenges.
•
Lack of adequate time to prepare the patient and family for the discharge. Sometimes,
there is a sudden pressure of making a bed ready for a patient (Naylor et al., 2011).
The physician discharge order may not match with the readiness of the nurses.
Limited time may also prevent the nurses and the entire hospital staff from engaging
the patients and their families in the discharge planning process.
•
Failure of the nurses and clinicians to incorporate the new communication approaches
into their care. This is so because they feel that the means used are correct; hence,
they may fail to see the need for better communication.
•
The sensitivity that is involved in negotiating interactions with the family members.
Most families are complicated; hence, making it difficult for the nurses to know
IMPLEMENTATION PHASE
5
which of the family members should be involved in the discharge planning process
(Naylor et al., 2011). It is, therefore, recommendable for the nurses to first ask the
patients on whom they prefer to be involved in their care at home.
•
Fear by the staff to change; some clinicians and nurses may fear losing control of the
process of discharge planning. When the use of the effective discharge planning
process is not checked, nurses and clinicians may go back to their primary ways.
Establish goals to improve the discharge planning process
Once the nurses and clinical staff understand the policies of families and the
challenges of the discharge planning, it will be easy to identify what needs to be improved
and the ways of measuring improvement (Nordmark & Lindberg, 2015). Setting goals help in
the development of the quality of the discharge planning process. The goal set should be
measurable, definite, and time specific. Some of these goals may be to reduce the number of
readmissions within a month, to increase the number of patients having the discharge
planning process within a specific period, and to have a certain amount of staff implementing
the effective discharge planning process.
Step 2: Decide on the ideal way of implementing the discharge planning process.
Once the team has established the goals, it will be useful to identify a single person
who shall be consulted in case of any question. This person may lack some answers to the
questions asked but may at least facilitate answers to these questions (Apkon & Friedman,
2014). Appointing this person will also make the process easy as people will know who to
turn to in case of any problem.
Decide on how to implement an effective discharge planning process.
IMPLEMENTATION PHASE
•
6
Decide on how to adapt and use the effective discharge planning process. Firstly,
decide on the elements of the effective discharge planning process that need to be
incorporated into the health system. There should be the consolation of the patient, the
family, and the hospital staff in case there are any changes. Compelling discharge
planning overview, process as well the list that fits the health care system should be
adapted (Naylor et al., 2011). The checklist can be posted on the computer in the
patient’s room to remind all the clinicians on the procedure to be followed. The list
may also be incorporated in the electronic records or may be used as an observation
sheet for continuous monitoring. The checklist may also be used to track critical
components in the discharge planning process. The roles of each member in the
discharge planning process should be verified. The members responsible for each task
should be identified, and what is expected of them.
•
Decide on the use and the adaption of the checklist and the booklet for the patient’s
family. It will be a preparation for the patient to go home (Naylor et al., 2011). The
hospital staff, the patient, and the family should be made aware in case of any
changes. Once the booklet and the checklist get adapted, decide on who will review
them, what approvals are required, and plan for their distribution.
•
Then plan on who will go over the checklist with the patient and the family at the last
discharge meeting.
•
Make a plan on integration of the checklist into discharge materials or current
admission.
•
Make a plan to discuss whether there will be a need for interpreters in the discharge
planning process.
•
Determine how the booklet and the checklist will be printed and distributed, whether
they will be distributed online or in a folder.
IMPLEMENTATION PHASE
•
7
There should be a plan on how awareness should be created among temporary staff
and how they will be involved in the entire discharge planning process.
Plan the ideal discharge planning training for the hospital staff such as the nurses
•
Decide on the person who will be in charge of the practice.
•
The patient and the family members who will be in charge of the training
•
The time that will be required in the preparation of the facilitators
•
During the training, learning strategies that are different should be used. These
learning strategies should include providing feedback, giving information, and
practicing skills.
Step 3: Implementation and Evaluation of the effective discharge planning process
Make sure the team is aware of the changes
•
Inform the directors who may not have been involved in the entire process. Let them
know why it is essential to implement an effective discharge planning process (Naylor
et al., 2011). The staff should be made aware through telephone, posters, and
meetings on the vital changes that have been made in the discharge planning process.
•
Training of the staff in the discharge planning process. The team to be trained will
include the nurses, caseworkers, and physicians. The main message to be given
emphasis will be:
o Improvement of the quality of home care services
o The training should progress throughout the entire discharge planning process.
Assess the implementation intensely during the first month and periods after that.
The hospital staff should have the support needed to implement the discharge
planning process. Make contact with the patient and family’s members and to know how they
IMPLEMENTATION PHASE
8
are progressing with the care giving (Nordmark et al., 2016). Get feedback from patients,
nurses, and families. It can be achieved d through the interviews and the questionnaires so as
find out the satisfaction level of the entire team involved in the overall discharge planning
process.
Refine the discharge planning process
The input obtained should be shared with the implementation team. The problem
should then be solved. Feedback and the tools should be refined before the implementation of
other units (Nordmark et al., 2016).
The table below shows an effective discharge planning process that utilizes four tools in
four weeks.
1st week
2nd Week
3rd Week
4th Week
Tool 1: Effective
Tool 2: Home
Tool 3:
Tool 4: Care
discharge planning
preparation of
Improvement of
Transitions from
process overview
booklet and
discharge outcomes
hospital to home
and checklist
checklist
with patients and
Inform the nurses
Discuss with the
about the new
family and the
Inform the concerned
be prepared to give
discharge planning
patient about their
Physician about the
maximum support to
process.
questions and
effective discharge
the patients and their
concerns.
planning process
families as they plan
families
Nurses and the entire
hospital staff should
to go home.
IMPLEMENTATION PHASE
9
References
Apkon, M., & Friedman, J. (2014). Planning for Effective Hospital Discharge. JAMA
Pediatrics, 168(10), 890. https://doi.org/10.1001/jamapediatrics.2014.1028
Miller, E. (2013). Discharge Planning – A Priority in the Care Delivery
Process. Rehabilitation Nursing, 38(5), 215-216. https://doi.org/10.1002/rnj.127
Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning
implementation in healthcare using normalization process theory. BMC Medical
Informatics And Decision Making, 16(1). https://doi.org/10.1186/s12911-016-0285-4
Naylor, M., Aiken, L., Kurtzman, E., Olds, D., & Hirschman, K. (2011). The Importance Of
Transitional Care In Achieving Health Reform. Health Affairs, 30(4), 746-754.
https://doi.org/10.1377/hlthaff.2011.0041
Running head: QUALITATIVE RESEARCH PROJECT PHASE TWO
Qualitative Research Project Phase Two
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 02/13/2020
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QUALITATIVE RESEARCH PROJECT PHASE TWO
Literature Review
Effective discharge planning is one that has been presumed to be a significant aspect
especially when discharging chronically ill patients, particularly in the intensive care units.
According to (McMartin, 2013), discharge planning is denoted as the procedure or process which
is initiated during admission in the hospital and during discharge. Naylor et al. (2011), asserts
that the transition care should be carried out effectively since it can help in curtailing healthcare
complications and hospitalizations after discharge. The primary aim of effective discharge
planning is to help in enhancing the care of the patients after they have been discharged from the
hospital. According to (McMartin, 2013), people who have chronic or critical conditions tend to
experience alterations in their health status. Through effective discharge planning, the health care
providers can obtain the chance of limiting the rates of hospitalizations after discharge since
effective discharge planning is accompanied by appropriate interventions, follow-ups, and
support services. A review conducted by (McMartin, 2013) affirmed that discharge planning
helps in declining hospital readmissions. In his review, (McMartin, 2013) also found out that
effective discharge planning can help in reducing the length of initial hospital stay. The reviewer
further denotes that during transitions in the health care settings, mistakes tend to emerge and can
result in medication errors. As well, transitions have the potential of increasing hospitalizations
hence the need for discharge planning in the health care settings. The author further affirms that
communication and planning before the discharge events are crucial aspects in making the aspect
of discharge planning more effective. Through discharge planning, the patients are provided with
the chance of communicating with their providers on how they can effectively manage their
chronic conditions.
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QUALITATIVE RESEARCH PROJECT PHASE TWO
Wong et al in (2011) researched to examine the barriers that deter effective discharge
planning. Through the qualitative study (Wong et al,2011) found out that it is imperative to
develop comprehensive systems and ensure that the roles of the staff individuals are clearly
defined to promote effective discharge planning. According to (Wong et al,2011) a systematic
approach should be incepted to help in developing the discharge planning structure and offer
quality care to patients. Accordingly, the discharge planning process should be policy-driven and
that both coordination and communication should be incorporated to help in enhancing the
effectiveness of the discharge process. Researchers further affirm that the process of discharging
patients is complex and challenging hence the need to incept measures for addressing the
challenges. Research by (Wong et al, 2011) found out that hospital discharge policies, review of
performance, capacity planning and stakeholders’ cooperation and engagement are critical
aspects for the inception of an effective discharge process in the health care settings.
An integrative research study by (Peltonen et al, 2015) sought to explore the
organizational aspects that result in or trigger the discharge delays and admission delays in the
intensive care units. According to the study, the researchers found out that both discharge and
admission delay in the intensive care units might result in adverse events and may increase the
costs of providing care to the patients. The review concluded that there is a need to carry out indepth research to ascertain the factors that result in a delay in discharge planning and admission.
From the review of literature, it is imperative to ascertain there is a gap in the study since
previous researchers have not expounded on the aspects or factors that deter effective discharge
planning for patients who are chronically ill in the intensive care units. The identification of the
factors that impact on effective discharge planning would help the health care providers to
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QUALITATIVE RESEARCH PROJECT PHASE TWO
ascertain the measures that should be undertaken to deal with the situation and ensure that the
methods of discharging the patients are effective.
Methodology and Design of the Study
The design of the study is the qualitative design involving the use of the interviews as the
data collection instruments. The primary rationale for deploying the use of the interviews as the
data collection instrument is that the interviews provide the chance for the researcher to carry out
an in-depth exploration of the views and perceptions of the participants regarding the topic of
study. The qualitative design is also an effective method of exploring the ideologies and
behaviors of people regarding a particular aspect (Suri, 2011). The embracement of the
qualitative design of the study would help in carrying out in-depth exploration and obtaining
information from the nurses that would help in ascertaining the factors that limit the
effectiveness of discharge planning for chronically ill patients in the intensive care units. The
study employs the use of 15 participants who are nurses in the INC within the area. The inclusion
criterion for the participants of the study is that the nurses chosen for the study should have
experience of more than two years of experience in the area of specialization and they should be
registered nurses. The exclusion criterion for the participants of the study is that the participants
or respondents of the study should be excluded if they experience in the area of specialization is
less than two years.
Sampling Methodology
The sampling methodology for qualitative research under discussion is the purposive
sampling technique. Purposive sampling is used to denote the technique in which the selected
4
QUALITATIVE RESEARCH PROJECT PHASE TWO
individuals or participants for the study have in-depth knowledge and experience in the topic of
interest. As well, in purposive sampling, the participants of the study have the willingness or
desire to participate in the study. It is heeded that in purposive sampling the participants or
respondents of the study should have the potential of communicating their ideologies and
experiences reflectively and expressively (Suri, 2011). One of the advantages of using purposive
sampling in the research under evaluation is that purposive sampling helps in obtaining the
participants with the required characteristics or attributes (Suri, 2011).As well, the information
obtained from the participants obtained through purposive sampling has a low margin of error
since the data or information is obtained from the respondents with knowledge in a particular
topic. For the study to evaluate the factors that limit effective discharge planning for ICU
patients under critical conditions, the use of purposive sampling is advantageous since the
researcher will obtain information from the relevant response. Ideally, the nurses in the study
provide health care services in the Intensive care units and therefore the information obtained
from the participants is validated. Therefore, the use of purposive sampling is appropriate for the
particular study.
Necessary Tools that will be incorporated in the Paper
One of the tools that will be incorporated in the paper is the interview sheet which will
include the questions or the inquiries that will be asked to the participants. As well, the consent
form will be included since it will seek to inform the participants on the role of the study. The
participants will be informed that their information will be used for research only. As well, the
data recording tools will also be prevalent since the information obtained from the participants
will e recorded and stored.
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QUALITATIVE RESEARCH PROJECT PHASE TWO
Flow Charts in the Paper
The paper will contain various charts that will be meaningful to the researcher as they
will help in validating the research study. One of the charts that will be used in the paper is the
one showing the exclusion and inclusion criterion for the participants of the study. As well, the
charts showing the results of the study will also be incorporated into the paper. The chart below
depicts the flow chart for the inclusion and exclusion criteria for the participants of the study.
The chart showing the results of the study will also be included. As well, the analyzed data will
also be depicted in form of charts to demonstrate on how the researcher arrived at the conclusion
of the study.
.Table 1: Exclusion and Inclusion Criteria
Inclusion Criterion
Exclusion Criterion
Registered nurse
Less than two years of experience in the area
of specialization.
Two years or more of experience in the area of
specialization
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QUALITATIVE RESEARCH PROJECT PHASE TWO
References
McMartin, K. (2013). Discharge Planning in Chronic Conditions An Evidence-Based Analysis.
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The
importance of transitional care in achieving health reform. Health affairs, 30(4), 746-754.
Peltonen, L., McCallum, L., Siirala, E., Haataja, M., Lundgrén-Laine, H., Salanterä, S., & Lin, F.
(2015). An Integrative Literature Review of Organisational Factors Associated with
Admission and Discharge Delays in Critical Care. Biomed Research International, 2015,
1-12. doi: 10.1155/2015/868653
Suri, H. (2011). Purposeful Sampling in Qualitative Research Synthesis. Qualitative Research
Journal, 11(2), 63-75. doi: 10.3316/qrj1102063
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). doi:
10.1186/1472-6963-11-242
7
Running head: IMPLEMENTATION PHASE
Implementation Phase
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 03/05/2020
1
IMPLEMENTATION PHASE
2
Implementation Phase
Implementation of effective discharge planning depends on the payment, finance
regulation, and the behavior of the service providers, policymakers, and the service recipient
(Miller, 2013). Health care facilities should always ensure that there is an effective discharge
planning process. Implementation of effective discharge planning follows the procedure of
assessing current patient needs, providing appropriate continued care needs, and recognizing
the resources that are available to meet care needs after the hospital.
Effective Discharge Planning Process
The first step of the effective discharge planning process is to include the patient
together with family members in the entire process (Nordmark et al., 2016). Engaging the
patient and the family is essential as the discharge is a process that takes place throughout the
patient’s hospital stay. It helps to identify the caregivers to be after the discharge of the
patient.
The second step of the effective discharge planning process is discussing with the
patient and family members the critical areas required for home care. These vital areas
include describing the home environment, the support that will be necessary, and what the
patient can and cannot eat. Another critical area is the reviewing of the medications (Miller,
2013). Warning signs and problems should also be marked. It will also be essential to explain
the test results to the patients and the family in case the results are available. In the cases
where the results are not available, the patient and the family members should be told on
when to wait for the results.
The third step of effective discharge planning is educating the patient and the family
about the condition of the patient, the process of the discharge, and the next discharge step
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throughout the hospital stay. The purpose of doing this is to help familiarize and increase the
confidence of those to become caregivers (Miller, 2013).
The fourth step of effective discharge planning is the assessment of how well the
nurses and the doctors explain the diagnosis and the next steps to the patient and the family
(Miller, 2013). Here, the patient and the family are provided with information in bits. The
patient and the family members are allowed to repeat this information to ensure that they
understand. The final step is listening to the family and the patient’s goals, preferences, and
concerns.
Implementation of an effective discharge planning process
Step 1: Forming a team to identify areas that need improvement
The group formed should be composed of nurses, management staff, hospital staff,
family representatives of the patient, and the patient (Nordmark & Lindberg). The patient and
the family contribute to the achievement of the effective discharge planning process. They
also provide feedback on what discharge planning process feels like as a patient and the
family members. Furthermore, the patient and the family members observe the nurse and the
hospital staff in determining whether they meet the elements of an ideal discharge planning
process.
Assessment of the visitation policies of the family should be done.
This will ensure that the family members are ever-present throughout the entire
process. If possible, the visitation policy should not just entail the visiting hours, but the
family members should always be allowed to be with their patients (Miller, 2013).
Assess the current view on the effective discharge planning process.
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Determine the steps taken for the effective discharge planning process. This checks on
how the nurses coordinate their interactions with the patient and the family (Naylor et
al., 2011). It also checks on whether those involved in the effective discharge
planning process are satisfied or not.
•
Determine the strengths of the effective discharge planning process. This checks if the
patient and the family members understand all the steps in their care (Naylor et al.,
2011). To determine the factors that encourages the patient and family engagement in
the discharge planning strategy.
•
Check on the areas that need improvement and the possible challenges in the
implementation of the effective discharge planning process.
Asses the challenges faced in changing of the staff behavior
The effective discharge planning process may require hospital staff, nurses, members
of the family, and the patient to adopt a new behavior. However, this may face the following
challenges.
•
Lack of adequate time to prepare the patient and family for the discharge. Sometimes,
there is a sudden pressure of making a bed ready for a patient (Naylor et al., 2011).
The physician discharge order may not match with the readiness of the nurses.
Limited time may also prevent the nurses and the entire hospital staff from engaging
the patients and their families in the discharge planning process.
•
Failure of the nurses and clinicians to incorporate the new communication approaches
into their care. This is so because they feel that the means used are correct; hence,
they may fail to see the need for better communication.
•
The sensitivity that is involved in negotiating interactions with the family members.
Most families are complicated; hence, making it difficult for the nurses to know
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which of the family members should be involved in the discharge planning process
(Naylor et al., 2011). It is, therefore, recommendable for the nurses to first ask the
patients on whom they prefer to be involved in their care at home.
•
Fear by the staff to change; some clinicians and nurses may fear losing control of the
process of discharge planning. When the use of the effective discharge planning
process is not checked, nurses and clinicians may go back to their primary ways.
Establish goals to improve the discharge planning process
Once the nurses and clinical staff understand the policies of families and the
challenges of the discharge planning, it will be easy to identify what needs to be improved
and the ways of measuring improvement (Nordmark & Lindberg, 2015). Setting goals help in
the development of the quality of the discharge planning process. The goal set should be
measurable, definite, and time specific. Some of these goals may be to reduce the number of
readmissions within a month, to increase the number of patients having the discharge
planning process within a specific period, and to have a certain amount of staff implementing
the effective discharge planning process.
Step 2: Decide on the ideal way of implementing the discharge planning process.
Once the team has established the goals, it will be useful to identify a single person
who shall be consulted in case of any question. This person may lack some answers to the
questions asked but may at least facilitate answers to these questions (Apkon & Friedman,
2014). Appointing this person will also make the process easy as people will know who to
turn to in case of any problem.
Decide on how to implement an effective discharge planning process.
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Decide on how to adapt and use the effective discharge planning process. Firstly,
decide on the elements of the effective discharge planning process that need to be
incorporated into the health system. There should be the consolation of the patient, the
family, and the hospital staff in case there are any changes. Compelling discharge
planning overview, process as well the list that fits the health care system should be
adapted (Naylor et al., 2011). The checklist can be posted on the computer in the
patient’s room to remind all the clinicians on the procedure to be followed. The list
may also be incorporated in the electronic records or may be used as an observation
sheet for continuous monitoring. The checklist may also be used to track critical
components in the discharge planning process. The roles of each member in the
discharge planning process should be verified. The members responsible for each task
should be identified, and what is expected of them.
•
Decide on the use and the adaption of the checklist and the booklet for the patient’s
family. It will be a preparation for the patient to go home (Naylor et al., 2011). The
hospital staff, the patient, and the family should be made aware in case of any
changes. Once the booklet and the checklist get adapted, decide on who will review
them, what approvals are required, and plan for their distribution.
•
Then plan on who will go over the checklist with the patient and the family at the last
discharge meeting.
•
Make a plan on integration of the checklist into discharge materials or current
admission.
•
Make a plan to discuss whether there will be a need for interpreters in the discharge
planning process.
•
Determine how the booklet and the checklist will be printed and distributed, whether
they will be distributed online or in a folder.
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There should be a plan on how awareness should be created among temporary staff
and how they will be involved in the entire discharge planning process.
Plan the ideal discharge planning training for the hospital staff such as the nurses
•
Decide on the person who will be in charge of the practice.
•
The patient and the family members who will be in charge of the training
•
The time that will be required in the preparation of the facilitators
•
During the training, learning strategies that are different should be used. These
learning strategies should include providing feedback, giving information, and
practicing skills.
Step 3: Implementation and Evaluation of the effective discharge planning process
Make sure the team is aware of the changes
•
Inform the directors who may not have been involved in the entire process. Let them
know why it is essential to implement an effective discharge planning process (Naylor
et al., 2011). The staff should be made aware through telephone, posters, and
meetings on the vital changes that have been made in the discharge planning process.
•
Training of the staff in the discharge planning process. The team to be trained will
include the nurses, caseworkers, and physicians. The main message to be given
emphasis will be:
o Improvement of the quality of home care services
o The training should progress throughout the entire discharge planning process.
Assess the implementation intensely during the first month and periods after that.
The hospital staff should have the support needed to implement the discharge
planning process. Make contact with the patient and family’s members and to know how they
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are progressing with the care giving (Nordmark et al., 2016). Get feedback from patients,
nurses, and families. It can be achieved d through the interviews and the questionnaires so as
find out the satisfaction level of the entire team involved in the overall discharge planning
process.
Refine the discharge planning process
The input obtained should be shared with the implementation team. The problem
should then be solved. Feedback and the tools should be refined before the implementation of
other units (Nordmark et al., 2016).
The table below shows an effective discharge planning process that utilizes four tools in
four weeks.
1st week
2nd Week
3rd Week
4th Week
Tool 1: Effective
Tool 2: Home
Tool 3:
Tool 4: Care
discharge planning
preparation of
Improvement of
Transitions from
process overview
booklet and
discharge outcomes
hospital to home
and checklist
checklist
with patients and
Inform the nurses
Discuss with the
about the new
family and the
Inform the concerned
be prepared to give
discharge planning
patient about their
Physician about the
maximum support to
process.
questions and
effective discharge
the patients and their
concerns.
planning process
families as they plan
families
Nurses and the entire
hospital staff should
to go home.
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References
Apkon, M., & Friedman, J. (2014). Planning for Effective Hospital Discharge. JAMA
Pediatrics, 168(10), 890. https://doi.org/10.1001/jamapediatrics.2014.1028
Miller, E. (2013). Discharge Planning – A Priority in the Care Delivery
Process. Rehabilitation Nursing, 38(5), 215-216. https://doi.org/10.1002/rnj.127
Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning
implementation in healthcare using normalization process theory. BMC Medical
Informatics And Decision Making, 16(1). https://doi.org/10.1186/s12911-016-0285-4
Naylor, M., Aiken, L., Kurtzman, E., Olds, D., & Hirschman, K. (2011). The Importance Of
Transitional Care In Achieving Health Reform. Health Affairs, 30(4), 746-754.
https://doi.org/10.1377/hlthaff.2011.0041