During discharge, transition takes place from hospital to rehabilitation or home and this period is critical for the health and wellbeing of the patients. It is an intimidating event and improvements need to done with proper discharge planning improving the outcome of patients as they move to next level of care (Kearns et al. 2017). It is expected from healthcare providers including nurses to take active participation in discharge planning so that proper care is give to patients as they transit from hospitals to residential cares or homes. Similarly, in the given case study, Jim Karas, 70 year old is being discharged from hospital to home as well as his wife, Amara. Therefore, the following report involves the discharge and care plan of client, Jim taking all ethical and legal principles into consideration in decision-making and providing a culturally safe plan of care.
Discharge and plan of care
Proper post-discharge planning and caring is important for patients ensuring the continuity of care between hospital and communities. Healthcare professionals should take an active part in the discharge planning so that there is proper improvement of coordination of services following hospital discharge (Holland, Knafl and Bowles 2013). The main care core principles state that understanding and dignity is the central tenant of achieving high quality care and support (Mitchell et al. 2014). To provide the best quality of care, key values of respect, dignity, skills, attitude and knowledge is required providing the best possible care. In the given case study, Jim Karas is being discharged from hospital to his home and require appropriate plan of care ensuring fast recovery and continuity of high quality of care. For a nurse, discharge planning is critical, however one can undertake the following key procedure that is mix of pre-planning and post-planning steps:
- Evaluation: A discharge planning is not only undertaking discharge orders or taking physical exodus into consideration, but also evaluation of patient by nurse or other healthcare professional. In this case study, nurse should consider the present condition of Jim as well as ensuring that he is fit to travel home after discharge.
- Discussion: The healthcare professional should discuss with Jim and her daughter Angela to be sure of care that will be given to him after hospital discharge as Jim is leaving professional care.
- Planning: Planning is required for Jim and his family members so that proper treatment and post-discharge care is given to him until he recovers completely.
- Determining: In case of Jim, logistics like carer is required as he was the sole carer for his wife Amara and Angela’ son is suffering from Autism Spectrum Disorder (ASD).
- Referrals: For securing care, appropriate steps need to be taken by nursing faculty and Jim’s daughter; Angela should refer to a home care agency as he is unwilling to go to a residential care home.
- Arranging: Follow- ups, diagnostic tests should be arranged in advance for Jim prior to discharge. This would help to keep plan of care on track and ready for implementation in the coming days (Gonçalves‐Bradley et al. 2016).
Care plan for Jim
The immediate care plan required for Jim is to stabilize his hypotension condition. There should be regular monitoring of his blood pressure to avoid any kind of complications like weakness, dizziness, fainting and risk of fall injuries. To manage hypotensive condition, it is advisable for Jim to avoid strenuous movements or activities that it can cause drop in BP. Appropriate posture is required for him like avoiding prolonged standing and elevated head while going to sleep (American Diabetes Association 2016). Apart from posture, proper meals are also required like cutting down of carbohydrates and resting after meals. He should be advised to intake high salt in his diet and drink lots of fluid to avoid instances of dehydration (Shibao, Lipsitz and Biaggioni 2013). If required, elastic or compression stockings can be worn covering calf and thigh helping to restrict blood flow to legs and keep more blood circulation in the upper body (Mills et al. 2015).
The second aspect of care involves the prevention further of CVC infection. It is important to teach Jim and his family members to practice good hygiene washing hands with soap and water or cleaning with hand gel that is alcohol based. The dressing should be kept touched only with clean and sanitized hands is crucial to avoid further central line infection (Blot et al. 2014). Medicine compliance is also important for Jim for fast recovery through antibiotics (Alkubati et al. 2015).
As Amara is dependent on Jim who is suffering from COPD and heart failure, caregiver should provide appropriate aid to them in executing the activities of daily living like dressing, bathing, eating and compliance to medications. In addition, Angela’s son is suffering for ASD, so the caregiver should be properly trained to care for the family members and helping them in their daily tasks. Utmost care should be taken by caregiver regarding their diet and in providing safe environment for fast recovery and in avoiding further complications. The nurse should contact the agency in Campbelltown, new South Wales, Australia for hiring caregiver or home carer for supporting his family through local services. In this community, Baptist Care Organization provides support for Jim like family support and aged care. They also provide financial support that can contribute to life-transforming care for Jim and Care Cell Emergency Response providing alarm for emergency call support enhancing independence of Jim and his family. This organization offers services in Greek language supporting his family. This organization also offers training to carers for learning skills in caring and gain access to resources and services that can help them to provide better care to Jim and his family.
Effective transition from acute care to community care is an important part of high quality care of patients and is one of the core duties of the hospitals. This activity is more effective when the hospital nurses, community providers and primary care physicians act together and communicate effectively to provide the required care interventions for the patients and the family members. The acute care nurses should not only provide references to Jim about local care but should themselves communicate with the local care providers and engage in discussion sessions. This would ensure that all the healthcare requirements that Jim and Amara need are met properly. Not only that, both should curve out detailed planning and engage in decision making about the approaches that both the patients would need at home ensuring that proper resources are provided to them on time. They should maintain the autonomy and dignity of both of them and engage them in all decision making. The acute care nurse should also aware the community nurse about their cultural backgrounds and help the local service in meeting the preferences of Amara specifically as she is not comfortable with English.
Ethical and legal principles
The ethical principle of autonomy suggests that patients should be allowed to make their own decision and take an active part in decision-making process. In the given case study, Jim wants to remain in his own home and strongly objects the option of residential care for him. In addition, he believes that he can take better care of Amara and they decided to stay in their own house instead of any residential home care or a small house or unit. In such instances, the nurse cannot go against his decision and force him to seek professional assistance. The nurse has to respect his decision complying with principle of respect for autonomy and dignity. Moreover, while respecting Jim’s decision, the nurse need to comply with principle of beneficence and non-maleficence. This can be explained in a way where the nurse should work towards promoting good health for the family members and fast recovery. The care plan should be focused on providing a safe environment for the family directed towards benefit and fast recovery (Pope, Hough and Chase 2016).
hrough effective communication skills (interpersonal skills), the nurse should explain Jim and his family members for seeking professional support as apart from Angela, other family members including Thomas who is suffering from ASD (Kourkouta and Papathanasiou 2014). The nurse should advocate strength-based approaches concentrating on strengths of Jim and his family members aiding empowerment and recovery. A qualified home carer should be appointed by the nurse from the local community who can support the family members’ needs and preferences (Jones 2017).
This approach in nursing is based on the fact that all individuals have their own strengths and while focusing on their interests and skills through empowerment. Through this, Jim and his family members would be able to overcome their emotional, physical and emotional trauma that they are facing in turn improving individual outcomes like health and quality of life. Strength-based nursing leadership can be helpful where Jim and his family members should be encouraged to take in charge of their health and responsible for healing and recovery. Through collaborative relationship between nurse and family members, the overall goal of health and wellbeing can be achieved (MacKie 2016).
Culturally safe care
While providing care to Jim’s family, nurse should develop care in a culturally competent manner. The family is originally from Greece and migrated to Australia. Therefore, the cultural differences can influence the plan of care for the family. Moreover, Amara is not comfortable speaking English and carer should be aware of their personal cultural beliefs and their perceptions towards health and illness. Culturally competent nursing can promote efficient care by discovering cultural beliefs and values of patients and being culturally aware in providing safe care while planning care for Jim and his family (Douglas et al. 2014).
For planning discharge and plan of care for Jim, utmost care should be taken advocating ethical principles of respect for autonomy and maleficence. Proper discharge planning should be done for his hypotension, central line infection due to CVC for Jim and his family members including Amara. Moreover, while planning care, proper care should be given their culture and maintain cultural sensitivity as they are originally Greek. As Jim does not want to go to residential care with his family, carer should be appointed who provide culturally sensitive care with respect for autonomy. Therefore, nurse should plan care helping Jim and his family to improve their health and quality of life with proper haling and recovery.
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