Welcome, BSN students, to Unit 11 of Fundamentals of Nursing. This lecture is crucial for understanding the dynamic processes of patient care within healthcare facilities. We will delve into the definitions, procedures, and profound nursing responsibilities associated with patient admission, transfer, and discharge, concluding with an exploration of patient psychological reactions to hospitalization.

1. Defining Key Terms: Admission, Transfer, and Discharge

Admission

Admission is the formal process of accepting a patient into a hospital or other healthcare institution for medical and nursing care. It signifies the commencement of structured care delivery within the facility.

Transfer

Transfer refers to the movement of a patient from one location to another. This can involve moving a patient from one flat surface to another (e.g., bed to stretcher), or from one unit to another, or even from one healthcare facility to an entirely different one. The patient may require assistance from nursing staff or assistive devices like stretchers or wheelchairs.

Discharge

Discharge is the process of a patient officially leaving a healthcare facility after their treatment is completed or their in-patient care is no longer required. This process ensures a smooth transition either back home or to another care facility.

2. The Admission Process: Procedures and Nursing Responsibilities

The admission process is multifaceted, ensuring the patient's safe and effective integration into the hospital environment.

Admission Procedure

  • Unit and Bed Preparation: Prior to the patient's arrival, the designated unit and bed must be thoroughly prepared, ensuring cleanliness, necessary equipment, and a welcoming environment.
  • Admission Process: This typically involves administrative tasks such as registration, obtaining patient demographics (name, address, contact, identification), assigning a hospital registration number, and directing the patient to their assigned unit and bed.
  • Special Considerations:
    • Emergency Admissions: For patients in acute, life-threatening conditions (e.g., accidents, poisoning, burns, cardiac/respiratory emergencies), immediate treatment takes precedence over administrative tasks, which can be completed by support persons later.
    • Medico-Legal Issues: Cases involving trauma, suicide attempts, or other legal implications require specific documentation and reporting protocols.

Types of Admission

  • Emergency Admission: Occurs when patients require immediate treatment for acute conditions.
  • Routine Admission: Planned admissions for investigations, diagnostic procedures, or medical/surgical treatments for stable conditions like hypertension or diabetes mellitus.

Role and Responsibilities of Nurses during Admission

Nurses play a pivotal role in ensuring a smooth and empathetic admission experience:

  • Meet and Receive: Greet the patient and family warmly.
  • Verify Patient Data: Cross-check records and introduce relevant personnel.
  • Assist and Orient: Escort the patient to their treatment area/bed and encourage them to change into a hospital gown.
  • Perform Examination & Evaluation: Establish baseline vital signs (pulse, BP, respiration, temperature), take a comprehensive patient history, and conduct a physical examination to identify any existing issues.
  • Coordinate Care: Collaborate with the physician to carry out initial orders (e.g., medication, diagnostic tests).
  • Provide Treatment Instructions: Educate the patient on their treatment plan.
  • Ensure Equipment Availability: Confirm all necessary equipment (e.g., oxygen cylinder) is readily accessible.
  • Patient Orientation: Explain the call system, telephone use, treatment schedule, and visitor timings.
  • Team & Policy Briefing: Introduce other healthcare team members and explain hospital policies and rules, including discharge procedures.
  • Manage Valuables: Document and secure patient valuables or ensure they are handed over to family members with proper signatures.
  • Complete Documentation: Fill out admission registers with all required patient information.
  • Friendly Demeanor: Maintain a friendly and compassionate attitude to alleviate patient and family stress.
  • Observation: Continuously observe the patient's condition (e.g., pain, anxiety).
  • Hospital Orientation for Relatives: Inform family members about hospital departments and policies.
  • Communicable Diseases: Implement strict infection control measures and consider isolating patients with highly transmissible diseases (e.g., viral meningitis).

3. The Transfer Process: Procedures and Nursing Responsibilities

Patient transfer, whether within the same hospital or to another facility, requires meticulous planning and coordination.

Definition of Transfer

Transfer means moving a patient from one bed to another, one room to another, one unit to another, or from one facility to another.

Types of Hospital Transfer

  • Intra-hospital Transfer: Movement from one unit to another within the same hospital.
  • Inter-hospital Transfer: Movement from one hospital to an entirely different hospital or facility.

Procedure for Patient Transfer

  • Physician's Written Order: Transfer must always be initiated by a physician's written order.
  • Inform Patient and Family: Educate the patient and their family about the reason and destination of the transfer.
  • Inform Receiving Unit: Notify the ward in-charge of the receiving unit to prepare for the patient's arrival.
  • Complete Documentation: Prepare a comprehensive discharge summary and ensure all patient documents, lab reports, and imaging results accompany the patient. A concise summary is critical for continuity of care.
  • Arrange Transport: Organize appropriate transport (e.g., stretcher, wheelchair, ambulance).
  • Inform Other Departments: Notify relevant hospital departments (e.g., lab, pharmacy) about the transfer.
  • Receive in New Ward: Ensure the patient is properly received and oriented in the new unit.
  • Handover Personal Belongings: Carefully transfer all patient belongings and document their receipt.
  • Documentation: Record the transfer in the patient's medical chart.

Nursing Responsibilities During Patient Transfer

Nurses are central to a safe and effective transfer:

  • Ensure Informed Consent: Confirm the patient and family understand the need for transfer and provide consent.
  • Effective Communication: Facilitate cooperation by clearly communicating the benefits of the transfer.
  • Patient/Family Decision-Making: The final decision to transfer (especially inter-hospital) rests with the patient or family.
  • Communicate with Receiving Agency: Provide detailed information to the new unit/facility about the patient's condition and care needs.
  • Medical Record Copies: Provide photocopies of all medical records to ensure continuity of care and prevent duplication of services.
  • Prepare Receiving Staff: Allow adequate time for the receiving staff to prepare for the patient's arrival.
  • Provide Written Transfer Summary: A concise summary of the patient's condition, treatment received, and reason for transfer is essential.
  • Manage Belongings: Meticulously gather all patient belongings to prevent loss or inconvenience.
  • Assist with Transportation: Physically assist with the transfer and ensure safe transport.
  • Provide Records to Transfer Personnel: Hand over a copy of the medical records to the person accompanying the patient during transfer.

4. The Discharge Process: Procedures and Nursing Responsibilities

Discharge is not merely leaving the hospital; it's a planned transition ensuring continued recovery and well-being.

Definition of Discharge

Discharge occurs when a patient leaves the hospital after completing treatment or when inpatient care is no longer necessary, transitioning home or to another facility.

Multidisciplinary Discharge Planning

Discharge planning is a collaborative effort involving the patient, family, medical staff, nursing staff, social workers, and dieticians. The physician formally plans and orders the discharge once the patient's recovery is confirmed.

Patient Concerns Post-Discharge

Patients often have concerns about self-care at home, managing dressings, medications, and follow-up care. Home health care provisions may be necessary.

Nursing Responsibilities During Discharge

The nurse's role in discharge is paramount for patient education and safety:

  • Ensure Patient Readiness: Confirm the patient is aware of and prepared for discharge.
  • Timely Information: Inform the patient and family well in advance of the planned discharge date.
  • Written Instructions: Provide all discharge instructions in written format for the patient to take home.
  • Specificity and Legibility: Instructions must be specific, easy to understand, and clearly written.
  • Family Notification: Ensure family members are informed to arrange transportation.
  • Patient Teaching: Comprehensive teaching includes:
    • Medication and Drug Regimen: How, when, and what dosage.
    • Diet: Specific dietary recommendations or restrictions.
    • Wound Care: Dressing changes, cleaning, and signs of infection.
    • Equipment Use: How to use any necessary medical equipment at home.
    • Exercise and Physical Activity: Recommended routines and precautions.
    • Physical Therapy: Specific exercises or movements.
    • Injections/Respiratory Treatment: Self-administration or home care for these treatments.
    • Home Health Care: Any necessary ongoing care at home.
    • Follow-up Appointments: Dates and times for post-discharge medical check-ups.
  • Documentation of Discharge:
    • Record the date and time of discharge.
    • Document how the patient left the facility (e.g., walked, wheelchair, stretcher).
    • Note any specific instructions given to the patient.
    • Document the return of all patient's personal belongings.

5. Patient Reactions to Hospitalization

Hospitalization is a significant life event that can elicit various emotional and psychological responses from patients.

Common Challenges and Changes

Patients often experience:

  • Changes in body image due to illness or surgery.
  • Confrontation with their own mortality.
  • Coping with altered relationships due to illness or isolation.
  • Dealing with increased levels of dependence on others.
  • Adjusting to physical changes and disabilities.
  • Grieving for losses (e.g., independence, previous lifestyle).
  • Fear of recurrent problems or complications.
  • Stress due to the hospital environment itself (e.g., unfamiliar surroundings, noise, loss of privacy, witnessing other patients' suffering).

Categories of Patient Reactions

Patients typically exhibit one of three primary reactions:

a. The Angry and Hostile Individual

Patients may become angry or hostile due to feelings of powerlessness and loss of control over their lives. This anger is often a reaction to their perceived inability to influence their circumstances and can be directed at staff, reflecting an uncomfortable experience they cannot verbalize directly.

b. The Agitated or Hyper-vigilant Individual

This response often stems from underlying anxiety, a feeling of helplessness, and a decreased sense of control over their illness. Increased discomfort and anxiety can lead to heightened agitation and hyper-vigilance, further exacerbating their unease.

c. The Withdrawn Individual

Withdrawn patients may appear lost or depressed. This reaction is concerning as their quiet demeanor might lead to them being overlooked in busy healthcare settings, potentially missing crucial assessment and intervention. Some patients may naturally be isolated or have minimal support systems, making them more prone to withdrawal, impacting their engagement in treatment.

Conclusion

Understanding and expertly managing patient admission, transfer, and discharge are cornerstones of professional nursing practice. By meticulously following procedures, fulfilling comprehensive responsibilities, and empathetically recognizing patient reactions to hospitalization, BSN students can ensure high-quality, patient-centered care throughout the entire healthcare journey. This foundational knowledge is vital for all future nursing endeavors.