Introduction

Going home from hospital is a welcome event for the majority of patients, where they can be assured of support from their families and a range of services. For others, it is a more worrying event, especially if they live alone and may have less access to services they might require. For the majority of patients, regardless of their level of support, there will be concerns about how they are going to manage after surgery. This concern will, of course, be dependent on the kind of surgery and, most importantly, what kind of diagnosis may have been the outcome (e.g. if a patient has undergone surgery for removal of a cancerous tumour, worry over whether it has all been removed or not). Psychological care and effective communication are two very important areas where the nurse has to develop skills, and as a student nurse you will be assessed in these areas as part of your ‘fitness for practice’ Nursing and Midwifery Council (NMC) (2010) standards (see Box 10.1 for examples of relevant competencies to be achieved).

Box 10.1 NMC (2010) Standards

Domain 2 – Communication and Interpersonal Skills

2.2. All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when language interpretation or other communication support is needed and know how to obtain it.

Domain 3 – Nursing Practice and Decision Making

3.3. All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities.They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement.

For students who have to achieve competencies according to the NMC 2004 standards, there are similar experiences to be achieved (please refer to your practice assessment documents for comparative competencies).

Preparation for discharge from hospital

Preparation for a patient’s discharge from hospital is a multidisciplinary team effort which is coordinated in most situations by the nurse. This person is referred to as the ward-based care coordinator in the Department of Health (DH) (2003) guidance. As can be seen in the DH (2003) principles, it is implicit in any policy to ensure that discharge planning should be co-ordinated by one person.

The DH (2003:46) sees this as part of ‘co-ordinating the patient journey’ and identifies the following key principles underpinning this aspect of effective discharge and transfer of care policy:

• Discharge is a process and not an isolated event. It has to be planned for at the earliest opportunity between the primary, hospital and social care organisations, ensuring that patients and their carer(s) understand and are able to contribute to care planning decisions as appropriate.

• The process of discharge planning should be co-ordinated by a named person who has responsibility for coordinating all stages of the patient’s progress. This involves liaison with the pre-admission case coordinator in the community at the earliest opportunity and the transfer of those responsibilities on discharge.

• Staff should work within a framework of integrated multidisciplinary and multiagency team working to manage all aspects of the discharge process.

Activity

Consider these three principles and ask your mentor if you can be involved in the discharge experience of a patient’s journey from hospital to home. Set out what your main learning objectives are in relation to the experience and use this as a goal for your expected learning outcomes in the placement. This could involve the discharge of a patient from a day care unit or a ward.

To help with this, obtain a copy of the article by Goodman (2010) (see References), which considers the importance of planning for discharge from hospital.

The nurse’s role in discharging patients home from hospital

If we use the idea of the nurse as the ward-based care coordinator, the DH (2003) document states that ‘this is an important, highly skilled role and requires an experienced practitioner who has a good understanding of discharge planning’. Key tasks considered to be important to this role are given in Box 10.2. The report suggested that this role could be enhanced to include nurse-led discharge.

Box 10.2 Care coordinator key tasks