Overview of Joseph’s Case

Discharge planning refers to a procedure that helps in bringing about an improvement in healthcare service coordination, following discharge of a patient from a hospital. It takes into account the needs of the patient, in the community in which he/she resides (Gonçalves?Bradley et al. 2016). The primary purpose of discharge planning is ensuring presence of continuity in the care quality between the community and the hospital. In other words, the objective of discharge planning is reduction of the length of hospitalization and readmissions to hospital, besides enhancing coordination of care services (Cameron 2018). The assignment will elaborate on the discharge plan of Joseph and formulate a culturally safe care and formulate an action plan for enhancing his optimal health and wellbeing.

Joseph is a 55 year old man of Australian descent who had been admitted to the Hospital’s emergency department following carbon monoxide poisoning due to a failed suicidal attempt. Joseph used for care for his wife Sophia (who has been diagnosed with Alzheimer’s disease, prior to his admission. He has been found to be medically stable and is soon to be discharged from the hospital.

Joseph had migrated to Australia along with his wife Sophia 35 years ago.  He usually described his life as perfect and well supported his family. Upon arriving in Australia, Joseph and Sophia became parents to a boy, and were able to successfully establish their business as well.  However, some of the most significant events that resulted in the suicidal attempt by Joseph included loss of contact with their son Robert, following his relocation to the United States for pursuing higher education, huge financial loss, and stress in providing care to Sophia and her progressing dementia. It was perceived by Joseph that caring for Sophia was his utmost responsibility but he was unable to do so, owing to the progressing old age and lack of support from his child. Despite repeated attempts by their son in admitting Joseph and Sophia to respite care services that deliver short term care for extremely sick or old people, they expressed disapproval at getting admitted to such services. 

Some of the most essential nursing assessments that must be conducted in Joseph in order to assess is overall health status encompass cultural, physical, spiritual, family, and mental health. Taking into account family health will also help in unravelling the different beliefs and values that are shared by all family members (Giger 2016). This can be facilitated by promoting a discussion with Sophia, and their son, while Joseph provides his consent for the same. Nursing assessment is not any specific test but comprises of a collection of information regarding the psychological, sociological, physiological, and spiritual status of a particular person. Hence, conducting a nursing assessment that would include his family members would necessarily form the first step of information gathering. The nursing assessment for also vital to discharge planning, due to the fact that discharging a patient from a healthcare setting is controlled by  different social, external, and cultural issues that might create an impact on the overall health and quality of well being of the service user (Zhu et al. 2015). The first and foremost step during discharge planning would be to establish a contact with the general practitioners who had evaluated Joseph.

Nursing Assessments and Discharge Planning

Suicidal thoughts refer to having or thinking about unusual preoccupations, related to suicide, and they range from extensive to fleeting thoughts with detailed planning, incomplete attempts, and role playing (Kleiman et al. 2017). Research evidences have elaborated on the fact that there are a range of negative life events of sudden life changeover that are responsible for bringing about a persistent state of distress and agony in the life of the sufferers, which in turn promotes them to attempt suicide (Blalock, Young and Kleiman 2015). Some of the major factors that might have played an essential role in the failed suicidal attempt are the sudden financial strain, distant relationship with son, increase in age, and poor health status of both self and his wife Sophia. 

The primary objective of the discharge planning process should be directed towards ensuring the health and safety of both Joseph and Sophia, and facilitating recovery from the present condition (Barkemeyer 2015). Taking into consideration the fact that Sophia was being given care by her husband, prior to his admission at the emergency department, her progressing Alzheimer’s disease should also be addressed adequately, while planning the discharge. Promoting effective ongoing treatment that is in accordance with their cultural values and beliefs will help in enhancing their quality of life. Adopting a non-judgmental approach towards treating the presenting complaints will also prove beneficial in establishment of positive health outcomes (Shay and Lafata 2015).

Research articles have elaborated on the fact that often there is a lack of congruence that exists between the preferences of the patients and their care give us, which in turn calls for the need of assessing the preferences of both the service user and their family members, during the early steps of discharge planning (Coyne 2015). Incorporating their demands and wants in the discharge planning process has been found beneficial in improving effectiveness of the care that is being given, enhancing overall health status. Therefore, involving the patient, his peers, and immediate family members during the planning process will help in gaining a sound understanding of the concerns, observations, and preferences. This will help in accomplishing the primary goal of maintaining continuity in the quality of care between the community and the hospital.

 Domestic support care has been found imperative in cases where the activities of daily living and general domestic duties are difficult to cope with, and the patients are unable to conduct them independently. Hence, assistance from the care workers would encompass paying attention to the domestic needs, and formulating a plan that will help in ensuring that all different activities are taken care of and scheduled (Low et al. 2015).  Joseph and Sophia should be provided support for food and drink preparation, feeding, cleaning, grooming, showering, and bed making. Besides they will also be referred to helpline services that have the provision of meals-on-wheels, which deliver food to the patients who are unable to prepare their own meals for purchase them. 

Promoting Cultural Safety in Discharge Planning

 Home care packages are a form of subsidy that is provided by the Government of Australia, in order to provide assistance to older people to live in their homes with adequate support. These packages will generally be flexible and provide a plethora of services that Joseph and Sophia can choose from according to their benefits (Slater and Hasson 2018). This will facilitate remaining independently at their homes, with control choice and flexibility. Depending on their eligibility for different levels of the packages the support services and quality care will be available to them on all days for 24 hours.  This will greatly enhance their living and personal need assistance that will be provided, besides medication reminders, social outings, appointment, transport, specialist dementia care, and palliative care (refer to appendix).

Culturally safe is in accordance with the major qualities of nursing that are inherent in all different types of nursing philosophy.  Thus, the discharge plan must be formulated in a way that the care services that are delivered day acknowledge the relationship between the patient and the nurse, while the former is experiencing a stress or an illness (Hole et al. 2015). While forming the discharge plan, all the family members should be consulted, apart from the patient. Developing an effective collaboration with the family will make them act as partners in the overall care process, with the aim of meeting the needs of the patient. All information regarding the discharge plan will be delivered in a manner that is culturally appropriate and respects the principles and perceptions of Joseph (Smith 2017). Hence, the practices and beliefs of the patient and his family must be acknowledged, while identifying the values that are inherent in the practice of nursing.   

Improving the transfer of care has been recognised as a major shared responsibility. Some of the most core principles that must be adhered to, while discharging Joseph from the hospital include the following:

• Strength based approaches
• Strong coordination and linkage across different sectors
• Equity in accessing shared services
• Family-centred and person-centred care (Primary Health Tasmania 2017)
• Interdisciplinary approaches

Transfer of care usually refers to moving a patient from a particular healthcare setting to another such as, from a nursing home to the community. Consequently, maintaining integration between the major healthcare providers is essential for minimising risks of potential errors, and ensuring that the patients are able to attend best health outcomes from the services and medication (Bohun et al. 2016).

Conclusion

 To conclude, Joseph and Sophia must also be educated on the potential benefits of the approaches that they will have an access to.  Providing education on the different strategies of self-management of Alzheimer’s disease would greatly benefit Sophia.  Provisions for counselling services would also help Joseph understand the adverse effects of suicidal ideations and the different ways by which such thoughts can be eliminated. All of these can be facilitated by development of an effective therapeutic relationship with the nursing professional who will provide help in making informed decisions, regarding self-care and facilitate the discharge process. 

References

Barkemeyer, B.M., 2015. Discharge planning. Pediatric Clinics, 62(2), pp.545-556.

Blalock, D.V., Young, K.C. and Kleiman, E.M., 2015. Stability amidst turmoil: Grit buffers the effects of negative life events on suicidal ideation. Psychiatry research, 228(3), pp.781-784.

Bohun, C.M., Woods, P., Winter, C., Mitchell, J., McLarry, J., Weiss, J. and Broberg, C.S., 2016. Challenges of intra-institutional transfer of care from paediatric to adult congenital cardiology: the need for retention as well as transition. Cardiology in the Young, 26(2), pp.327-333.

Cameron, B., 2018. The impact of pharmacy discharge planning on continuity of care. The Canadian journal of hospital pharmacy, 47(3).

Coyne, I., 2015. Families and health?care professionals’ perspectives and expectations of family?centred care: hidden expectations and unclear roles. Health expectations, 18(5), pp.796-808.

Giger, J.N., 2016. Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.

Gonçalves?Bradley, D.C., Lannin, N.A., Clemson, L.M., Cameron, I.D. and Shepperd, S., 2016. Discharge planning from hospital. Cochrane Database of Systematic Reviews, (1).

Hole, R.D., Evans, M., Berg, L.D., Bottorff, J.L., Dingwall, C., Alexis, C., Nyberg, J. and Smith, M.L., 2015. Visibility and voice: Aboriginal people experience culturally safe and unsafe health care. Qualitative health research, 25(12), pp.1662-1674.

Kleiman, E.M., Turner, B.J., Fedor, S., Beale, E.E., Huffman, J.C. and Nock, M.K., 2017. Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of abnormal psychology, 126(6), p.726.

Low, L.F., Fletcher, J., Gresham, M. and Brodaty, H., 2015. Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?. Australasian journal on ageing, 34(3), pp.E1-E8.

Primary Health Tasmania., 2017. Guidelines for Shared Transfer of Care. Available from https://www.primaryhealthtas.com.au/sites/default/files/Guidelines%20for%20Shared%20Transfer%20of%20Care.pdf [Accessed on 23 September 2018].

Shay, L.A. and Lafata, J.E., 2015. Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making, 35(1), pp.114-131.

Slater, P. and Hasson, F., 2018. An evaluation of the reablement service programme on physical ability, care needs and care plan packages. Journal of Integrated Care, 26(2), pp.140-149.

Smith, A., 2017. Pacific nursing: Culturally-safe care needed. Kai Tiaki: Nursing New Zealand, 23(11), pp.39-39.

Zhu, Q.M., Liu, J., Hu, H.Y. and Wang, S., 2015. Effectiveness of nurse?led early discharge planning programmes for hospital inpatients with chronic disease or rehabilitation needs: a systematic review and meta?analysis. Journal of clinical nursing, 24(19-20), pp.2993-3005.