The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [47]
Planning and implementing care
When planning care, it is vital that nurses recognize whether patient problems require nursing care or whether a referral should be made to someone else.
When a nursing diagnosis has been made, the anticipated outcome for the patient must be identified in a manner which is specific, achievable and measurable (NMC 2009).
Nursing interventions should be determined in order to address the nursing diagnosis and achieve the desired outcomes (Gordon 1994).
Evaluating care
Nursing care should be evaluated using measurable outcomes on a regular basis and interventions adjusted accordingly (Box 2.11).
Progress towards achieving outcomes should be recorded in a concise and precise manner. Using a method such as charting by exception can facilitate this (Murphy 2003).
Documenting and communicating care
The content and quality of record keeping are a measure of standards of practice relating to the skills and judgement of the nurse (NMC 2009).
In addition to the written record of care, the important role that the nursing shift report, or ‘handover’, plays in the communication and continuation of patient care should be considered, particularly when considering the role of electronic records (Ballard 2006).
(Reproduced with kind permission of the Royal Marsden Hospital NHS Foundation Trust 2005)
Discharge planning
Definition
Discharge planning is defined by Rorden and Taft (1990) as ‘a process made up of several steps or phases whose immediate goal is to anticipate changes in patient care needs and whose long-term goal is to ensure continuity of health care’.
Related theory
Discharge planning should involve the development and implementation of a plan to facilitate the transfer of an individual from hospital to an appropriate setting and include the multidisciplinary team, the patient and their family and carers. Furthermore, it involves building on, or adding to, any assessments undertaken prior to admission (DH 2003a). It is acknowledged that the activities required to achieve a safe and timely discharge of patients back into the community are complex (DH 2010).
The nurses’ ability in this task is central to a good discharge and requires them to have a clear understanding of how to assess the patient’s and carer’s needs (Atwal 2002, Reilly et al. 1996). Determining the discharge needs of a patient returning to the community is, as suggested by Foust (2007, p.73), ‘a first and complex step’ in the discharge planning process.
One of the key elements of the Clinical Governance agenda is improved quality and effectiveness (DH 1998a). Good-quality discharge should reduce delayed discharges (Tarling and Jauffur 2006) and facilitate meeting the targets set by various Department of Health publications (DH 2000a, 2002, 2004a). It is evident from the literature that there is growing pressure to ensure patients have a better discharge experience and that hospitals work to improve the discharge planning processes (Maramba et al. 2004, Mistiaen et al. 2007, Salter 1996).
Therefore all hospitals should have a discharge policy which is developed, agreed and ideally jointly published with all the relevant local health and social service agencies. The Department of Health (2003b) states in its guidance on discharge policy development that this ‘will need to be understood by staff’ and highlights the importance of training through induction and ongoing education programmes. Standards should be applicable to the planning and delivery of care at all stages: preadmission and admission; the period as an inpatient; predischarge; the discharge process and postdischarge (Health Services Accreditation 1996). Patient preadmission clinics are an ideal opportunity to assess care required on discharge (DH 2003a). It is worth ensuring that the information gathered at preadmission is shared with community staff, as they may be able to commence their