1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9 Continuity of Care

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Nurse in Community-based Care Provide continuity of care when patient moves from one level of care to another. Provide interventions. Promote health. Manage acute or chronic illness. Promote self-care.

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Establishing an Effective Nurse–Patient Relationship Reduce anxiety through therapeutic communication, teaching, and acceptance. Remember that the patient has other concerns and needs other than medical ones. Communicate with the patient as an individual. Take time to learn about the patient being admitted. Provide for family participation in all aspects of care.

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. In same-day surgery clinics, screening tests and teaching take place upon admission to the clinic. A. True B. False

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. False In same-day surgery clinics, screening tests and teaching take place prior to admission to the clinic.

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission to Ambulatory Care Setting Patient receives healthcare services but does not remain overnight. In most offices and clinics, patients complete a short health history. In same-day surgery facilities, screening tests, teaching, and admission take place before patients enter the setting.

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission to the Hospital Admission sheet becomes part of the medical record. Bracelet is placed on wrist of patient. A nursing interview and physical assessment are conducted. A room is prepared for the patient.

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following information is printed on the patient identification bracelet? A. The date of birth and address of the patient B. The patient identification number C. The name and phone number of the nearest relative D. The patient’s financial status for healthcare payment

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. The patient identification number Rationale: The identification number, as well as the patient’s and physician’s name, is printed on the identification bracelet that is placed on the patient’s wrist.

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Information Obtained on the Admission Sheet Name, address, and date of birth of patient Gender and marital status Name of admitting physician Name of nearest relative Occupation and employer Financial status for healthcare payment Religious preference Date and time of admission/admitting diagnosis Identification number

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing a Room for a Patient Position and open the bed. Assemble necessary equipment and supplies. Assemble special equipment and supplies. Adjust the physical environment of the room.

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Transfer Within Hospital Setting Move patient’s personal belongs to a new room. Transfer patient chart, Kardex, care plan, and medications. The nurse in the old area gives verbal report to the nurse in the new area.

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing for a Patient’s Arrival

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Information Included in Verbal Report Patient name and age Physicians and admitting diagnosis Surgical procedure, if applicable Current condition and manifestation Allergies, medications, and treatments Necessary laboratory data and special equipment Nursing care priorities Existence of advance directives

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false When transferring a patient to a long-term care facility, the original chart, which is a legal document, remains at the hospital. A. True B. False

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. True When transferring a patient to a long-term care facility, the original chart, which is a legal document, remains at the hospital.

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Transferring a Patient to a Long-Term Facility A copy of the chart is usually sent with the patient. Detailed assessment and care plan is sent. The nurse often provides verbal report to the new nurse.

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Essential Components of Discharge Planning Assess strengths and limitations of the patient, family, or support person. Assess the environment. Implement the plan of care. Consider individual, family, and community resources. Evaluate effectiveness of care.

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Planning for discharge begins when the patient receives discharge orders from the physician in charge of care. A. True B. False

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. False Planning for discharge begins on admission when information about the patient is collected and documented.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Criteria for Formal Discharge Plan and Referrals Lack of knowledge of treatment plan Social isolation Recently diagnosed chronic disease Major surgery Prolonged recuperation Emotional or mental instability Complex home care regimen Financial difficulties Lack of available or appropriate referral sources Terminal illness

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Providing Written Instructions for Self- Care at Home

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Guidelines for Discharge Planning Assess and identify healthcare needs. Set goals with patient. Teach patient and family. Provide home healthcare referrals. Evaluate discharge planning effectiveness.

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements accurately describes part of the process involved when a patient leaves AMA? A. The patient is not legally free to leave without being discharged. B. The patient leaving AMA must sign a form releasing the nurse from legal responsibility for health status. C. After signing the form, the patient should be informed of any possible risks involved with leaving AMA. D. The patient’s signature must be witnessed, and the form becomes part of the patient’s record.

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: D. The patient’s signature must be witnessed, and the form becomes part of the patient’s record. Rationale: A patient is legally free to leave the hospital against medical advice (AMA). The patient must sign a form releasing the physician and healthcare institution and should be informed of any risks prior to signing the form.

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Leaving AMA Patient is legally free to leave. Choice carries a risk for increased illness or complications. Patient must sign a release form. Patient is informed of risks prior to signing form. Patient’s signature must be witnessed. Form becomes part of medical record.