An Aspects Of Discharge Planning Nursing Essay

An Aspects Of Discharge Planning Nursing EssayThis assignment looks at the communication strategies to support and empower the long-suffering living with COPD, a Long enclosure Condition and their Signifi stick outt Others when planning their demean from hospital. This is based on Mr metalworkers scenario, a 78 years old man who suffers from advanced chronic obstructive wayways disease. It depart open with the definition of the keywords of the assignment. It will examine the characteristics of COPD at end of stage in the first section, because this is what Mr Smith suffers from and will therefore determine the discharge packet of sustenance to be used for him. The second section will look at the discharge plan and the team to be regard in the discharge process and their role. Finally it will look at the importance of communication when planning discharge and the communication strategies to be utilised for Mr Smith.As a amour of fact, Mr Smith suffers from COPD, which descri bes the obstruction of airflow caused by chronic bronchitis, emphysema, or both. It is called chronic because it is persistent, and pulmonary because it affects lungs. Bronchitisis about the inflammation of the airways of the lung, while emphysema is the damage which affects the smaller airways and air sacs of the lungs. He has suffered from serious exacerbations as his conditions has been worsening beyond normal solar day-to-day variations and is acute, with symptoms such(prenominal) as worsening breathlessness,coughing, increased sputum coloured production. He is instanter classed as having end of stage COPD. Even though there is no accepted definition for end of stage COPD (Siafakas, 2006), the term end of stage gives the estimate of the last step in the course of a progressive disease. NICE (2010) classifies COPD into four stages, Mild (stage I), moderate (stage 2), severe (stage 3) and very severe (stage 4). According to leader (2012), end stage COPD refers to last stages o f the disease. According to Global Initiative for ChronicObstructive Lung Disease(2010), very severe COPD would rent the following chronic symptoms cough with a lot of mucus, severe breathlessness, loss of weight, skin colour becoming blue, edema attacking the legs and feet, Life-threatening COPD flare-ups and Lung malfunction.At this point, it should be kept in nous that Mr Smith is the first person to be involved in this discharge planning as his preferences must be considered in the process. He has to be charge to take responsibility of his own care. It is part of the NMC (2008) policy that nurses have to listen to people in their care and respond to their needs and preferences, and get informed hope if required. Mr Smiths family members should alike be involved as they are the ones to be with him at home. They can inform the discharger of their avail efficacy, willingness, strength and limitations. Involving patients and carers in the discharge planning process is rattling one of the requirements of the Department of Health (2010).The discharge planning will therefore start with an opinion through spirometry tests of Mr Smiths condition looking into his complete medical history. The care suppliers should harness out how much air Mr Smiths lungs can blow in and out. It is known that Mr Smith was previously admitted to the hospital for exacerbations. This subject matter that a serious assessment of his respiration system should be do with a look at the level of dyspnea. The discharge is based on his request, which means that he should be involved in the process.The condition of Mr Smiths workaday activity can be thought to be difficult, because his medical history shows that his condition worsened and his house had to be amend to accommodate his needs, and that he now lives in his front room downstairs and has access to the toilet down stairs as well his kitchen/dining area. This means that Mr Smiths coping skills are very limited. Mr Smith shoul d also be assessed for cardio vascular and other chest diseases and psychological effects caused by COPD.Mr Smith therefore appears to have functional problems as his exertion is very limited which affects his activity of daily living. So his discharge planning should include assessment of functional abilities to determine his ability to be independent in the future and the possibility of exercising. This assessment will do to determine whether he needs treatment for pulmonary rehabilitation and how virile and flexible he can be. This helps to assign the right job to physiotherapists.Several interventions have to be done in order to reduce risk factors (NICE, 2010). Donna and Goodridge (2006) has depict a number of symptom burden for end of stage COPD patients dyspnea, breathlessness with discomfort burden of fatigue and sleep disturbances, which has impact on functional limitations of daily activities such as self care, household chores, and leisure activities. (Elkington et al 2005) feeling of social isolation and loneliness, depression and foreboding, (Lacasse, 2001), panic, fear, and frustration. Tranmer et al (2004) goes a step further to play feelings of worry, sadness, nervousness, irritability, and concentration difficulty. Finally the needs of the patients family should be taken into consideration, because they are the people to stay with the patient at home, and are therefore the patients advocates, companions, personal caregivers, and surrogate decision-makers (Selecky, 2005) addicted the services to be involved in Mr Smiths discharge planning, one can correctly identify the process as a complex discharge planning as it involves multidisciplinary care planning and ongoing care. Actually, this discharge plan calls for a multidisciplinary team of professionals as suggested in NICE (2007). Even though the patient mud under the care of the hospital consultants while making the GP aware of the home care, this team of professionals will work with re ferrals coming from secondary care in order to care for Mr Smith at home.A respiratory nurse specialist will set and implement the care in order to repair Mr Smiths respiration. This will help to reduce any anxiety and fear. The in-reach nurse will educate, support and advise the different parties mainly patients, his relatives and staff and assess the various devices to be used as well as organise the followup and other referrals to competent departments and services (spirometry, chest checkup ). Physiotherapists will help with exacerbation at home to clear secretions and provide chest physiotherapy at home as well as advise the patient on breathing image and exercises that might help Mr Smiths mobility problems. However a proper training is required for nurses, because there appears to be a limitation in their knowledge and the way to kettle of fish with end of stage COPD patients. (Disler and Jones, 2010)The palliative care for Mr Smith should be based on the above symptoms as sociated with advanced COPD. Oxygen therapy will be needed, because COPD patients usually endure hypoxaemia with the progression of the diseases. This is not a curative treatment, but it helps relieve the symptoms of breathlessness. However it has been observed that caution should be taken for the respiratory drive not to be suppressed by a lack of control. Here one has to distinguish between long term atomic number 8 therapy which takes around 15 hours a day and short term therapy for other patients.Given that Mr Smith has suffered from serious exacerbation, there is a need for Oxygen therapy, and a respiratory specialist should be delegate to control the use of oxygen. Since Mr Smith will be going home, and his need of oxygen is great an oxygen concentrator with a back up supply of oxygen cylinder could be a better alternative. A proper training for its use must be given to his careers. There would also be a need to include steroid tablets such as prednisolone in his treatment i n order to reduce the extra inflammation in the airways. This can be taken once a day for 5 to 14 days. Dyspnea can be treated with the use of opioids which improves breathlessness. (Jennings et al, 2002) A 20mg dose of viva morphine a day also would be helpful (Abernethy et al, 2003).Airway Clearance Devices can also be prescribed in case Mr Smith has problems to clear secretions and mucus. High-frequency chest wall oscillation, or a utter valve can be used with a positive expiratory pressure of about 6-20 cm H2 O (Ambrosino et al, 1995).Mr Smith should also be considered to receive treatment for psychological effects, as these have been observed in patients with advanced COPD because of the poor quality of life. Patients suffers from anxiety and depression due to dyspnoea (Bailey 2004), and this is said to be in the proportion of up to 90 %. (Kunik et al 2005 Norwood 2006). In this case, consideration would be given to antidepressants such as benzodiazepines, paroxetine and sertr aline which have proven effective for anxiety and depression (Lacasse et al 2004). As NICE (2010) recommends, this treatment should be supplemented by spending duration with the patient to explain why all this is happening and how it can be treated. This calls for the importance of profound communication. A check up is also necessary to find out if Mr Smith is coughing, in which case Morphine and codeine could be prescribed.COPD patients also feel pain in the chest, which can have a musculoskeletal or pleuropulmonary origin (Leach 2005), in which case some analgesic drugs proposed by the WHO, can be used, mainly non opioids such as paracetamol and NSAIDs weak opioids such as codeine and tramadol and backbreaking opioids. But in case of infections, consideration should be given to antibiotics.At this point, Mr Smith and his family should be educated in the way medications should be taken to keep off nonadherence to the medical plan. By Adherence, one should understand an active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result. (Delamater, 2006). This calls for a clear understanding by Mr Smith of his condition (Johnson G, et al, 2005) and fitting the medication regime to his daily routine (Ryan and Wagner, 2003). This can be done if there is good communication. Communication should be understood as a process of conveying information and thoughts between different people, using written or spoken language and body language. Several scholars have found that communication is paramount to deliver good healthcare (Buckley, 2008), because both the patient and the healthcare provider enter into an emotional relationship. (Wittenberg-Lyles et al., 2008). It has also been observed that patients have a great need of information about their condition and that inadequacy of communication in healthcare would prevent good provision of care for people at the end of life. (Curtis et al, 200 5). Actually while planning for communication, one can also include distribute Directives in the form of living will or proxy while Mr Smith is still stable in order for him to have a parcel of land in his last wishes. Communication should be part of all those concerned with the discharge planning for a better understanding of who would be doing what, and this meets the NMC (2008) requirement to share information with colleagues so working as a teamThe nurse has therefore to avoid to create a communication gap with the patient, and other professionals, or say any misunderstanding in what they are talking about. It should be kept in mind that open communication is likely to empower the patient to have more than hope and so dispel any fear they have (Davidson and Simpson, 2006). With such a view in mind, communication with the patient would help to share hope and prepare for death, or in Back et al (2003)s terms to hope for the best and prepare for the worst, and discussion of que stions link to worries, concerns for the future, hope (Braun et al 2007) as well as information related to the outcomes of different treatments with survival chances given with honesty (Fried et al 2002) Empathy should be among the strategies while interacting with the patient, and the nurse has to devote more time to listen to the patient. (Edwards et al, 2006). Actually nurses need more training in the field of communication for patients at end of stage as correctly mentioned by Davidson et al, 2002.To conclude, it can be said that Mr Smiths discharge plan is a complex plan with a multidisciplinary professionals involved. The plan starts with an assessment of Mr Smith condition and moves to focus on providing education and reinforcement of the medical plan. The medical plan includes pharmacological details describing medications intended to alleviate Mr Smiths symptoms of severe COPD, as well as non- pharmacological ones related to the devices to use and control of adherence and coping skills of Mr Smith. The pharmacological part should include medication to do with COPD and the psychological effects produced. A nutritional assessment is also necessary. Among the treatment, aspects of pulmonary rehabilitation, exercising, community resources should be included. Communication should be a key issue not only between the professionals and mr Smith, but also between the professionals themselves for the good of the patient. All these aspects call for a better training for nurses, as at present literature reveals that nurses express limited confidence in their knowledge and how to contest with aptients at end of stage COPD.