ADMISSION OF PATIENT IN HOSPITAL – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
ADMISSION OF PATIENT IN HOSPITAL
Definition of Admission of Patient in Hospital:
Hospital admission may be defined as “Receiving a patient to stay in the hospital for observation, investigation diagnosis, treatment and care”.
or
Admission of patient means, allowing a patient to stay in the hospital for observation, investigation and treatment of the disease he is suffering from.
or
Hospital admission is the act or process of accepting someone into a hospital, clinic, inic, or other treatment facility as an inpatient.
Purposes of Hospital admission:
1. To welcome the patient and establish a positive relationship with patient and close relatives.
2. To offer immediate management and care in acute conditions.
3. To orient patient to immediate environment and services available.
4. To acquire baseline data of a patient through history and physical examination.
5. To collaborate with patient in planning and providing comprehensive care.
Articles which is needed for admission of a patient in hospital:
1. Prepared bed.
2. Thermometer tray
3. B.P. apparatus.
4. Weighing machine (scale).
5. Admission advisory form (from admitting department).
6. Complete form of admission forms (in the file or chart)
7. Documents such as-
- Doctors order sheet
- TPR sheet
- Nursing assessment sheet
- Nursing record
- Progress record
- Lab master sheet
8. Articles for physical examination according to the patient’s illness.
9. Kidney tray or emesis basin.
10. Tissue paper.
11. Bedpan and urinal
12. Bath towels and wash cloth.
Procedure of Admission of Patient in a Hospital:
1. Prepare admission bed/ room before the patient entering in the ward/room/bed.
2. Introduce yourself to the patient. Greet/welcome the patient’s warmly.
3. Orient the patient (helping a patient become familiar with a new environment) to the unit and the entire ward.
- The location of nursing station, toilet, shower or bathing area and lounge available to the patient and visitors,
- Where clothing and personal items can be stored,
- How to call for nursing assistance from bed and bath room.
- How to adjust the hospital bed. How to regulate the room’s light and fan.
- How to use the telephone and any policy about diverting incoming calls to the nursing station during the night.
- How to operate the television.
- The daily routine such as meal time. When the doctor usually visit.
- When surgery is scheduled (if needed).
- When laboratory or diagnostic test are performed
4. Explain roles of the personnel who will be caring for the individual introduce him to all staff and other patient.
5. Explain the daily routine of the ward including meal time, medication and visiting hours.
6. Explain to the patient what his rights are observing policies in dealing with medico legal cases.
7. Obtain and record vital signs high and weight.
8. Collect specimen as needed.
9. Take nursing history and health history to established a database for the patient and complete the admission record.
10. Encourage the patient to ask questions and clarify doubts.
11. Review and explain the purposes of consent. Take consent from the patient or relatives after proper explanation.
12. Record the collected data of the patient in the records file so that every one concerned will be familiar with the patient.
13. The doctor of the patient should be introducing to him and patient should feel free to talk about his problems to the doctors.
14. Start the individual nursing care plane and carry out the admission orders of the doctors.
15. Take care of the patient’s valuables and clotting.
16. Helping the patient during undress-
- Providing privacy.
- Have the patient sit on the edge of the bed
- Encourage patient to remove his/her shoes.
- If the patient is helpless, weak or tired help him her to remove dress
DISCHARGE
Definition of Discharge
Discharge planning is a centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for conferring care after leaving the hospital.
Discharge from the hospital is the point at which the patient leaves the hospital and either returns home or is transferred to another facility such as one for rehabilitation or to a nursing home. Discharge involves the medical instructions that the patient will need to fully recover.
General Principles of Discharge of a Patient from Hospital:
1. Patient and family understands the diagnosis, anticipated level of functioning, discharge medications and anticipated medical follow up.
2. Specialized instructions or training is provided to the patient and family to ensure that proper care
3. Community support systems are coordinated to enable the patient to return home.
4. Relocation of the patient and coordination of support system or transfer to another health care facility are performed.
Purposes of Discharge:
- To ensure continuity of care by providing instructions and guidelines.
- To prepare patient physically and emotionally for to transfer to the changed environment.
- Determine need and make referrals for home health care or extended care services.
- Ensure client ability to perform self-care after discharge.
- Provide family members with knowledge and skills needed to administer care to client in a home setting.
Procedure of Discharge of a Patient From Hospital:
1. Assess patient’s health care needs at the time of discharge using nursing history, care plan and ongoing assessment of physical abilities and cognitive function from time of admission.
2. Assess patients and family’s need for health teaching related to home therapies, restrictions resulting from health alterations and possible complications.
3. Assess with patient and family any environmental factors within home that might interfere with self-care, e.g. size of room, bathroom facilities, stairs etc.
4. Collaborate with physician and staff in other disciplines, e.g. physical therapist, social workers etc.
5. Consult other health team members about needs after discharge e.g. dietitian, social worker. Make appropriate referrals.
6. Preparation before day of discharge:
- Suggest ways to change physical arrangement of home to meet patient’s needs if required.
- Provide patient and family with information about community health care resources.
- Conduct teaching sessions with patient and family as soon as possible during hospitalization in anticipation of preparation for discharge, e.g.-signs and symptoms of complications. Use of medical equipment etc.
7. Day of discharge:
- Allow patient and family questions.
- Check physician’s discharge orders for prescription and change in treatments.
- Determine whether patient or family has arranged for transportation home.
- Check all closets and drawers for belongings.
- Obtains copy of valuables when required.
- Provide patient with prescriptions for medications ordered by physicians.
- Provide information about follow up visit and home health care facilities available.
- Provide printed teaching material as per patient’s requirement with necessary instructions.
- Obtain wheel chair for patients who are unable to ambulate.
8. Complete documentation of patient’s discharge in nurse’s notes.
9. Ensure that the discharge summary from physician is ready.
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