PHASE 1- PLANNING
Introduction to the problem
Transitional nursing is Care provided to patients as they transit from one place to another. Transition can be within the hospital setting, between care settings, within health states. And between providers (Warchol et al., 2019). One of the transitions is discharge from the hospital to home care. Patients are discharged from the hospital before they are completely cured. But must be well off to be able to recover at home. The patients are sent home with treatment packages. And sometimes may require frequent clinical visits by the nursing for care.
The care plan during the transition from hospital to home care includes the treatment goals. The health status of the patient, treatment preferences. And family as well as patient education. Coordination is crucial in this care. In some cases. These discharge packages are not well elaborated. Miscommunication and discontinued care may result in adverse effects on the patient. For example, the patient may experience delayed care, unnecessary clinical visits. And stress to the patient or family. And poor health outcomes.
The transition of the hospital to home care is done to enable the client to recover at home. Healthcare professionals discharge clients with strict instructions for the client. To continue with care and recover fast. Due to poor communication and nursing care at home. Many patients face readmission. Readmission is defined as the return to hospitalization within 30 days of discharge from the same condition. Readmission is among the costliest cases in the hospital setting to manage. Hospitals incur huge costs in managing readmission. The federal government is also affected. The US spends $17.4 billion on readmission costs. Hospitals readmit 20% of patients enrolled in Medicare within 30 days upon discharge. And 34% of the clients within 90 days of discharge.
Unwanted and unnecessary health care costs amount to $765 billion yearly. With preventable admission accounting for $17 billion for Medicare (Warchol et al., 2020). Causes of readmission are varied. Poor resolution of the original problem of the patient is a major cause of readmission. The healthcare provided by professionals just relieves the pain. And not the actual problem. In such a case it is likely to reoccur. Discharge of patients too early may be a cause of readmission. The patient is discharged before being stable enough to recover from home. In other cases, inadequate care after discharge may make the condition worse. The nurse has a critical role to play in the provision of care at such transition (Rezapour-Nasrabad, 2018).
Significance of the study
The significance of this study is to inform nurses of the gaps within the hospital-home transition care. And informing the necessary course of action to prevent readmission of clients. The study will identify the major problems nursing practitioners face in transition care. Transition care costs health facilities billions of dollars which could be avoided with proper intervention. Proper communication and collaboration between health care providers post and Pre discharge can provide coordinated care for better health outcomes. Adequate care post disgrace will reduce the rate of readmission. The study will be significant to clinics and other healthcare centers. The billions of dollars that government spends on readmission could be channeled to other treatment avenues. Nurses and doctors can work in harmony and coordinate care during the transition. Through education of patients, families, effective care is possible and can help to reduce readmission.
Purpose of the study
The purpose of this study is to investigate methods nurses use to reduce the readmission of patients after discharge. Most patients undergo a state of depression together with their kin. Because of the reoccurrence of diseases that could be avoided before discharge. Going back to the hospital makes it costly for instance to people who are not enrolled in health insurance cover (Upadhyay et al., 2019). In the US, the costs families incur during readmission dent their economic stability. Resulting in them using coping strategies to mitigate the financial challenges. The study will assess the major methods that can be used by clinicians to prevent readmission.
Treatment of the main condition rather than the symptoms as well as proper communication between health professionals during discharge is essential in promoting patient recovery. In addition, nurses can take an active role in improving care for patients in a transition phase. Making the necessary interventions can reduce the rates of readmission in the hospital setting. The hospital should be a temporary place for the treatment of patients before discharge within the shortest time possible. Long hospital stay is associated with poor health outcomes and increased costs.
The study wishes to find key issues surrounding nursing care during the transition. The nurse has a critical role in the management of students to minimize readmission rates. Some of these research questions to be addressed include;
1. What strategies can hospitals put in place to prevent readmission of patients?
2. What is the role of nurses in the transition care of patients?
3. What is the role of hospital management in ensuring they reduce readmission costs?
4. What is the purpose of communication between professionals before the discharge of patients?
Masters essentials aligned to the study
Nursing care is an essential component in patient management. Nursing skills acquired in training can be well utilized to provide comprehensive. And timely care to all patients. During transition care, nurses’ efforts ought to be recognized. And acquired to assist patients to recover well at home. Or any other transitory place or setting. Research gaps still exist that nurses can explore. And recommend necessary actions for continuous implementation in patient management. With the proper application of nursing theories. Nurses can develop philosophies that can go a long way in changing patient care in hospitals and beyond. Developing a research problem statement should be the pursuit of any nurse who wishes to contribute immensely in the field of medicine.