1. Preparation for discharge 2 Preparation for discharge is an important part of admission, assessment, monitoring and evaluation.

2. 2007PFothergill2 Preparation for discharge: what to do Read the case study, notes and learning outcomes on the following slides. Link the case study, notes and learning outcomes to start identifying relevant issues – the resources on the last slide are to help get you started. Make your own notes and bring these to the discussion /feedback session.

3. 2007PFothergill3 Preparation for discharge: learning outcomes Working (thinking, information gathering and discussing) with this scenario will help you to: Recognise the role of the nurse in the promotion of health and self-care Develop an awareness of the nurse’s role in participating in providing health promotion interventions Develop an awareness of the key health and social factors to be considered when carrying out an assessment of individual needs Increase your awareness of the contributions of other professionals to assessment, planning, implementation and evaluation of nursing care

4. 2007PFothergill4 Scenario Charles is 73 years old. He was born in Jamaica and has lived in Yorkshire since 1959. He has two daughters but was separated from their mother when the children were young and is estranged from his family. His physical health has been good all his life, but he suffers from occasional depression, for which he receives treatment. Some weeks ago, he was attacked by youths in the estate where he lives and slipped, fracturing his right femur. He was admitted to your ward, where he has gradually regained mobility. You are Charles’s named nurse. You attend the case conference at which his discharge from hospital is discussed.

5. 2007PFothergill5 Additional notes Following the case conference yesterday, Charles’s doctor told him that it was time to start making arrangements for his return home. Since then, Charles has been very withdrawn. He told the physiotherapist that his leg was too painful for him to do his exercises today. He appears to be alarmed at the prospect of returning to his flat.

6. 2007PFothergill6 Assessment Now that you have this baseline information - what else do you want to know? For example: What influences the ways an individual or group might define health? What might Charles consider are his immediate needs regarding his discharge from hospital? How might these differ from those of the multi-disciplinary team (MDT)? Put yourself in Charles’s position and try to understand the situation from his perspective.

7. 2007PFothergill7 Your role in this situation You might think that the multidisciplinary team appear to be taking a functional view of Charles’s health because assessments appear to focus only on his ability to feed and dress himself, move about and do everyday tasks. What other aspects of Charles’s health might be assessed at this stage? Think how models of nursing might guide you (the nurse) in assessing Charles’s health needs. What is the nurse’s (your) role in this situation?

8. 2007PFothergill8 What else could you do to help? Identify examples of people, resources, agencies and processes that would contribute to Charles’s preparation for discharge. Briefly describe how the different agencies/individuals of the multi/interdisciplinary team could collaborate to help Charles to prepare for going back home. Outline Charles’s long-term care needs and identify which of the agencies/individuals could be involved.

9. 2007PFothergill9 Resources Discharge from Hospital: pathway process and practice (DH, 2003) http://www.doh.gov.uk/hospitaldischarge/ Change Agent Team website http://www.doh.gov.uk/changeagentteam/ Reimbursement website http://www.doh.gov.uk/reimbursement/ Modernisation Agency website http://www.modernnhs.nhs.uk/ NSF for Older People http://www.doh.gov.uk/nsf/olderpeople/ Intermediate Care http://www.doh.gov.uk/intermediatecare/icmovingforward.htm