Academic literature on the topic 'Hospital discharge education'

Readmission after bariatric surgery occurs in about 5% of cases and increases the average costs up to 2.5-fold. Risk factors for readmission are dependent functional status, diabetes mellitus, steroid or immunosuppressant use, cardiac disease with intervention, bleeding disorders, longer operative time, concurrent splenectomy, high preoperative creatinine, low serum albumin, and occurrence of postoperative complications during index admission. The most common reasons for readmissions are procedure-related complications, including dehydration, abdominal pain, bleeding, anastomotic leak, gastroi

Home enteral tube feeding (HETF) 106Home parenteral nutrition (HPN) 108Equipment supply is usually arranged through a home care company. Good communication between patient, family, and healthcare professionals is a prerequisite for effective discharge planning. The needs of the child and family must be clearly identified in order to prepare transfer from hospital to home. It is also essential that continuing care arrangements are in place with coordinated action from all involved (family, healthcare professionals, social services, education, voluntary bodies, etc.)....

Psychoeducation is a well-established approach to patient care for individuals coping with severe mental illness. Psychoeducation is an umbrella term for a group of intervention models designed to provide information, guidance, and support to individuals with severe mental illness and their families. Originally developed to help families and patients with schizophrenia and other serious mental illness, psychoeducation has subsequently been adapted to other mental and chronic illness. Psychoeducation curricula have been tailored to distinct cultures, norms, and health payer systems. Because most psychoeducation models allow a certain amount of flexibility in curriculum, psychoeducation can readily translate into community settings. Given the increasing importance of patient education as part of the hospital discharge process and demonstrated cost savings associated with multifamily psychoeducation groups, it is likely that psychoeducation will grow in importance for application not only to psychiatric illness but also to other medical conditions.

Children present to the health services with a variety of health needs. The Department of Health (DH) National Service Framework (2004) in the United Kingdom (UK) identifies that children with health needs should receive good quality care. Furthermore this care needs to be provided by staff that have adequate preparation to work with children and families (DH, 2004). In order to provide such care, the nursing student needs to develop and acquire the necessary knowledge and skills to gain an understanding and appreciation of the common needs of both family and child on hospitalization. This chapter aims to equip you with the knowledge and background skills to enable you to provide this quality care. After reading this chapter you should be able to: ● Identify and outline the essential skills that are required during the child’s admission to hospital. ● Understand the essential clinical observations that are performed upon the child’s admission to hospital. ● Develop a further understanding of the basic elements of admission and discharge planning, including the nursing process and care planning. ● Understand the importance of good record keeping during care. ● Identify the means of transmission of infection and the specific precautions and practices that the nursing student can utilize to prevent such transmission. ● Understand the principles of distraction therapy. ● Understand the situations in which restraint may be required. ● Comprehend the principles of last offices and the nurse’s role in providing bereavement care. This chapter assists with your understanding of your nursing care by helping you to understand the skills that can be used during the child’s admission to hospital. These skills develop with experience and education and enable you to develop a caring, family centred approach that makes the transition from home to hospital and vice versa a smooth one for both family and child. Crucially, the assessment process, in the initial phase, helps to set the scene in your relationship with both child and family and communication skills are vital. At the same time essential physical observations of the child are carried out and documented to support your overall assessment and these will be outlined in this chapter.

Handover of patient care is a time of particular risk and it is important that accurate and relevant information is clearly communicated. The hospital discharge letter is an important part of handover. However, the quality of hospital discharge letters is variable and letters frequently omit important information. The Cork Letter-Writing Assessment Scale (CLAS) checklist is an itemized checklist developed to improve the quality of discharge letters. The CLAS checklist, with an inbuilt scoring system, is available as the CLAS mobile application. Mobile applications offer an exciting opportunity for ‘point of practice' knowledge acquisition and are widely used by medical students. Content quality is integral to the success of educational mobile applications. In a recent study, the CLAS checklist improved the quality (content, structure and clarity) of discharge letters written by medical students. Though retention of these skills into the work-place and effects on patient safety have yet to be demonstrated, the development of standardized electronic discharge letters allows faster and safer transfer of information between healthcare providers and is a welcome advance. Using Near Field Communication for mobile applications to seamlessly transfer discharge letters between devices is another important feature.

It is important that we differentiate between leadership and management right at the outset, and this differentiation can be seen in this statement. However, initially, we will consider both individually and as different facets of what you as a student nurse are required to learn to achieve your competencies to practise as a registered nurse. The concept of team working is explicit throughout this chapter. Recent years have seen the issue of nursing leadership become an important issue for the future of nursing generally, and, most importantly, specifically in relation to the major changes in health and social care, and subsequently in direct nursing care. Patients now require more intensive interventions; bedside technology continues to thrive and, with a more rapid discharge system and quicker throughput of patients in hospitals, many organizations are in search of a workforce who can manage their workload effectively, whilst providing leadership to others. Employers are looking for qualified nurses who can provide supervision, management, development, administration, and coordination of services to patients and employees (Mahoney 2001: 269). In his letter to the Prime Minister summarizing the interim report of the National Health Service (NHS) Next Stage Review (Department of Health 2007: 3), Lord Darzi set out his aim to convince and inspire everyone working in the NHS to embrace and lead change. Every time you go on duty with an aim to care for patients, whatever their number, you require some degree of skill and potential to lead others to help you to collaborate with your colleagues. The Nursing and Midwifery Council (NMC) Standards for Pre-Registration Nursing Education (NMC 2010) now make it explicit how student nurses are expected to achieve competencies in these areas and state in the Standards: Each field of practice also has its own field-specific competencies related to this domain—that is, competencies that are specific to the main service users that are the focus of the respective field of care.

A cohort study is one in which the outcome (usually disease status) is ascertained for groups of individuals defined on the basis of their exposure. At the time exposure status is determined, all must be free of the disease. All eligible participants are then followed up over time. Since exposure status is determined before the occurrence of the outcome, a cohort study can clarify the temporal sequence between exposure and outcome, with minimal information bias. The historical and the population cohort study (Box 9.1) are efficient variants of the classical cohort study described above, which nevertheless retain the essential components of the cohort study design. The exposure can be dichotomous [i.e. exposed (to obstetric complications at birth) vs. not exposed], or graded as degrees of exposure (e.g. no recent life events, one to two life events, three or more life events). The use of grades of exposure strengthens the results of a cohort study by supporting or refuting the hypothesis that the incidence of the disease increases with increasing exposure to the risk factor; a so-called dose–response relationship. The essential features of a cohort study are: ♦ participants are defined by their exposure status rather than by outcome (as in case–control design); ♦ it is a longitudinal design: exposure status must be ascertained before outcome is known. The classical cohort study In a classical cohort study participants are selected for study on the basis of a single exposure of interest. This might be exposure to a relatively rare occupational exposure, such as ionizing radiation (through working in the nuclear power industry). Care must be taken in selecting the unexposed cohort; perhaps those working in similar industries, but without any exposure to radiation. The outcome in this case might be leukaemia. All those in the exposed and unexposed cohorts would need to be free of leukaemia (hence ‘at risk’) on recruitment into the study. The two cohorts would then be followed up for (say) 10 years and rates at which they develop leukaemia compared directly. Classical cohort studies are rare in psychiatric epidemiology. This may be in part because this type of study is especially suited to occupational exposures, which have previously been relatively little studied as causes of mental illness. However, this may change as the high prevalence of mental disorders in the workplace and their negative impact upon productivity are increasingly recognized. The UK Gulf War Study could be taken as one rather unusual example of the genre (Unwin et al. 1999). Health outcomes, including mental health status, were compared between those who were deployed in the Persian Gulf War in 1990–91, those who were later deployed in Bosnia, and an ‘era control group’ who were serving at the time of the Gulf war but were not deployed. There are two main variations on this classical cohort study design: they are popular as they can, depending on circumstances, be more efficient than the classical cohort design. The population cohort study In the classical cohort study, participants are selected on the basis of exposure, and the hypothesis relates to the effect of this single exposure on a health outcome. However, a large cohort or panel of subjects are sometimes recruited and followed up, often over many years, to study multiple exposures and outcomes. No separate comparison group is required as the comparison group is generally an unexposed sub-group of the panel. Examples include the British Doctor's Study in which over 30,000 British doctors were followed up for over 20 years to study the effects of smoking and other exposures on health (Doll et al. 1994), and the Framingham Heart Study, in which residents of a town in Massachusetts, USA have been followed up for 50 years to study risk factors for coronary heart disease (Wolf et al. 1988). The Whitehall and Whitehall II studies in the UK (Fuhrer et al. 1999; Stansfeld et al. 2002) were based again on an occupationally defined cohort, and have led to important findings concerning workplace conditions and both physical and psychiatric morbidity. Birth cohort studies, in which everyone born within a certain chronological interval are recruited, are another example of this type of study. In birth cohorts, participants are commonly followed up at intervals of 5–10 years. Many recent panel studies in the UK and elsewhere have been funded on condition that investigators archive the data for public access, in order that the dataset might be more fully exploited by the wider academic community. Population cohort studies can test multiple hypotheses, and are far more common than any other type of cohort study. The scope of the study can readily be extended to include mental health outcomes. Thus, both the British Doctor's Study (Doll et al. 2000) and the Framingham Heart Study (Seshadri et al. 2002) have gone on to report on aetiological factors for dementia and Alzheimer's Disease as the cohorts passed into the age groups most at risk for these disorders. A variant of the population cohort study is one in which those who are prevalent cases of the outcome of interest at baseline are also followed up effectively as a separate cohort in order (a) to study the natural history of the disorder by estimating its maintenance (or recovery) rate, and (b) studying risk factors for maintenance (non-recovery) over the follow-up period (Prince et al. 1998). Historical cohort studies In the classical cohort study outcome is ascertained prospectively. Thus, new cases are ascertained over a follow-up period, after the exposure status has been determined. However, it is possible to ascertain both outcome and exposure retrospectively. This variant is referred to as a historical cohort study (Fig. 9.1). A good example is the work of David Barker in testing his low birth weight hypothesis (Barker et al. 1990; Hales et al. 1991). Barker hypothesized that risk for midlife vascular and endocrine disorders would be determined to some extent by the ‘programming’ of the hypothalamo-pituitary axis through foetal growth in utero. Thus ‘small for dates’ babies would have higher blood pressure levels in adult life, and greater risk for type II diabetes (through insulin resistance). A prospective cohort study would have recruited participants at birth, when exposure (birth weight) would be recorded. They would then be followed up over four or five decades to examine the effect of birth weight on the development of hypertension and type II diabetes. Barker took the more elegant (and feasible) approach of identifying hospitals in the UK where several decades previously birth records were meticulously recorded. He then traced the babies as adults (where they still lived in the same area) and measured directly their status with respect to outcome. The ‘prospective’ element of such studies is that exposure was recorded well before outcome even though both were ascertained retrospectively with respect to the timing of the study. The historical cohort study has also proved useful in psychiatric epidemiology where it has been used in particular to test the neurodevelopmental hypothesis for schizophrenia (Jones et al. 1994; Isohanni et al. 2001). Jones et al. studied associations between adult-onset schizophrenia and childhood sociodemographic, neurodevelopmental, cognitive, and behavioural factors in the UK 1946 birth cohort; 5362 people born in the week 3–9 March 1946, and followed up intermittently since then. Subsequent onsets of schizophrenia were identified in three ways: (a) routine data: cohort members were linked to the register of the Mental Health Enquiry for England in which mental health service contacts between 1974 and 1986 were recorded; (b) cohort data: hospital and GP contacts (and the reasons for these contacts) were routinely reported at the intermittent resurveys of the cohort; (c) all cohort participants identified as possible cases of schizophrenia were given a detailed clinical interview (Present State examination) at age 36. Milestones of motor development were reached later in cases than in non-cases, particularly walking. Cases also had more speech problems than had noncases. Low educational test scores at ages 8,11, and 15 years were a risk factor. A preference for solitary play at ages 4 and 6 years predicted schizophrenia. A health visitor's rating of the mother as having below average mothering skills and understanding of her child at age 4 years was a predictor of schizophrenia in that child. Jones concluded ‘differences between children destined to develop schizophrenia as adults and the general population were found across a range of developmental domains. As with some other adult illnesses, the origins of schizophrenia may be found in early life’. Jones' findings were largely confirmed in a very similar historical cohort study in Finland (Isohanni et al. 2001); a 31 year follow-up of the 1966 North Finland birth cohort (n = 12,058). Onsets of schizophrenia were ascertained from a national hospital discharge register. The ages at learning to stand, walk and become potty-trained were each related to subsequent incidence of schizophrenia and other psychoses. Earlier milestones reduced, and later milestones increased, the risk in a linear manner. These developmental effects were not seen for non-psychotic outcomes. The findings support hypotheses regarding psychosis as having a developmental dimension with precursors apparent in early life. There are many conveniences to this approach for the contemporary investigator. ♦ The exposure data has already been collected for you. ♦ The follow-up period has already elapsed. ♦ The design maintains the essential feature of the cohort study, namely that information bias with respect to the assessment of the exposure should not be a problem. ♦ As with the Barker hypothesis example, historical cohort studies are particularly useful for investigating associations across the life course, when there is a long latency between hypothesized exposure and outcome. Despite these important advantages, such retrospective studies are often limited by reliance on historical data that was collected routinely for other purposes; often these data will be inaccurate or incomplete. Also information about possible confounders, such as smoking or diet, may be inadequate.

A number of studies conducted since the turn of the millennium have identified several deficits in engineering education; the most widely cited are deficits in critical analysis, systems thinking, and visualizing non-linear cause-effect chains. The field of engineering education has undergone a number of notable changes in response to such identified deficits but recent field studies such as Vision 2030 identified remaining shortfalls in engineering competencies as well as significant discrepancies in the perception of the severity of these deficits. While academic engineering programs feel th

Objectives: To study cases of cervical cancer managed/unmanaged in rural India and to analyze the reasons for poor outcome. Methods: This is a retrospective study of 218 cases of cervical cancers between 2008-2013 with resultant outcome in terms of treatment or absence of treatment in spite of diagnosis. Reasons for not taking the treatment have been analyzed. Also, analysis of 21 cases of simple hysterectomy with resultant complications like VVF, RVF has been done. Indications of surgery, operating surgeon, availability of preoperative/postoperative HPR, slides/blocks, discharge summary and d