THE UNIVERSTIY OF THE WEST INDIES
FACULATY OF MEDICAL SCIENCES
U.W.I SCHOOL OF NURSING MONA
In Collaboration with
BROWN TOWN COMMUNITY COLLEGE SCHOOL OF NURSING
BACHELOR OF SCIENCE IN NURSING
YEAR 3 SEMESTER 3- 2012
SENIOR NURSING ELECTIVE WITH STUDY SEMINAR
NURS 3039 NE39A
June 22, 2012.
Selection and description of the problem
Education at discharge is a vital component of improving outcomes. Education of patients at discharge promotes self-care, reduces readmissions, and helps patients identify problems early, increasing the chances for intervention and improved outcomes.
Rationale for selection
Poor adherence to discharge teaching leads to worsening of disease and rehospitalization. According to estimates, 54% of readmissions may be preventable, and inadequate discharge planning and education or lack of patient follow-up is common factors in readmission (source). Lack of compliance with medications, failure to follow diet, and delays in seeking medical attention are among the primary reasons for the high rate of rehospitalization among patients (source).
Implication for nursing practice
INTEGRATION OF RESEARCH TO SUPPORT THE RECCOMMENDATIONS
Recommendations clearly identified
Selection of current research evidence supporting the recommendations
Logical discussion of arguments
Performance measures are criteria used by organizations to determine whether an organization is fulfilling its vision and meeting its patient-focused goals. These measures are standardized to evaluate hospitals in order to promote positive outcomes in patient care. They may reflect medical management of patients, but they may also assess aspects of patient care, that is education of patients and their families at discharge. The latest guidelines for management of heart failure recognize the importance of education and recommend that patients receive educational materials as part of the patients’ complete discharge instructions (source). These materials should address recommended activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if signs or symptoms worsen. It is unclear whether the discharge instruction performance measure as recorded in the hospital reflects whether the patients did or did not receive each defined component of education. Patient education may be documented in the medical record even if the education was cursory and allowed little time for the patient to absorb and retain the information.Conversely, many patients and their families are not ready to learn at the time of diagnosis, regardless of how thorough the instructional session may be. As such, extensive education may be better absorbed when a patient is in a stable condition and has adapted to living with disease. Fonarow et alconcluded that current performance measures related to heart failure, have little effect on patients’ outcomes shortly after discharge. Hence, additional measures and/or better methods for identifying and validating performance measures related to heart failure may be needed to improve care and outcomes of patients with heart failure.
Critical pathways and in-hospital instructional tools may improve the provision and quality of discharge education. The AHA Get With the Guidelines heart failure program is a hospital-based quality improvement program whose key component is the Patient Management Tool, a Web-based interactive assessment and reporting system that tracks treatment and facilitates evidence-based medicine. This tool includes education as part of the overall discharge checklist. Although many hospitals are adapting the tools, its presence alone is not enough to guarantee evidence-based practices. Use of a team leads to quick and sustained improvements.
One-on-one sessions between a...
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