IDEAL Discharge Planning Strategy – Care Example

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"IDEAL Discharge Planning Strategy" is a well-written example of a paper on care. After patients have spent their time at the hospital and have started showing signs of recovery, it is important that they will be discharged home. The discharging process is however not to be an end to a means but a means to an end. This means that discharging the patient must not be seen as the end of the role of the nurse or health professional (Windom, Burgess, Crane, et al. , 2011). Discharging must only be seen as a transition in the health care process from the hospital as the center of care to the home (Pearson, Ryland & Harrison, 2010).

But in order to achieve this, it is important that the discharge process will be well planned and guided in its delivery. It is for this reason that this discharge plan is being prepared for the 6-year-old boy who is being made ready for discharge from the hospital. The boy had been at the hospital for 4 days with asthma. As part of the discharge, the patient will be using a nebulizer and metered dose inhaler at home.

The essence of this discharge plan is to ensure that the patient is given much education on the use of the metered-dose inhaler and the nebulizer. It is hoped that the plan will help in reducing and eventually stopping the pathological process that has resulted from asthma. Objectives The objectives of this discharge plan are to: See the patient transit from hospital to the home Education the patient on the use of metered-dose inhaler and nebulizer Put in place interventions to stop the pathological process that result from asthma  Analysis To achieve the objectives, the nurse will use what has been known as the IDEAL discharge planning strategy.

The name of this discharge planning strategy is taken from acronyms built for IDEAL. The meaning of IDEAL as given by the Agency for Healthcare Research and Quality (AHRQ) (2010) has been spelled below. Include the patient and family in the discharge planning process as stakeholders Discuss with patient key areas to prevent problems at home Education patient and family about the current condition of the patient and the next steps to take Assess how well the discharge process has been from the point of all service providers involved Listen to and honor patient and family goals and concerns about the patient and his condition Planning The patient and family will be engaged in 30 minutes of health teaching that borders on the current state of the patient.

Specifically, it will be explained to the patient and family that the condition of asthma has not been totally healed but has been brought under control, which when all intervention processes are followed can make the patient even better.

After this, the activities expected to be involved in the intervention will be spelled out to the patient. These activities have been given a vivid explanation below. The patient and family will then be asked to enumerate the activities that were given out to them. Very specifically, the patient and family will be made to role-play the use of a nebulizer. The rationale for doing this is to ensure that the patient and caregivers at home (parents) will have a hands-on approach to responding to the interventions that will be put in place. Interventions The following interventions are provided to be followed as the patient goes home.

The section has been tabulated to clearly outline intervention, the rationale for selecting it, and comments on how the intervention stops the pathological process resulting from asthma. Intervention Rationale for Intervention Response to Pathological Process Allowing for much mucus plug expulsion as possible This intervention will ensure that there is the sustenance of respiratory function, which will subsequently relieve patients of bronchoconstriction (Hart and Davidson, 2009). The pathological process resulting from asthma leads to the presence of tenacious plugs of exudates and mucus occluding the airway (Christopher, Wood, Eckert, et al. , 2003).

this intervention will thus clear plugs and thus free the airway for proper functioning. Use a metered-dose inhaler periodically to inject a specific amount of medication to treat the onset of symptoms of asthma. Since there is a narrowing of the breathing airways, the patient finds difficulty in the air movement activity of the lung (Windom, Burgess, Crane, et al. , 2011). The metered-dose inhaler is thus needed to support the transfer of medication into the lung. One of the pathological processes is that the airway surface epithelium becomes frail (Pearson, Ryland & Harrison, 2010).

This intervention will therefore stop further frailty by rather putting the metered-dose inhaler to work The patient must be placed in a semi-fowler position most of the time. This semi-fowler position will encourage diaphragmatic breathing to take place. This intervention will stop the pathological process associated with the base of the epithelial reticular membrane becomes thickened because there will be a better function of the lung. Reinforce the use of a nebulizer to suppress chemical mediators and nerves found in the bronchial tubes. The activity of chemical mediators and nerves located in the bronchial tubes are responsible for the muscles becoming constricted and leading to Bronchospasm (Hart and Davidson, 2009).

  This intervention will therefore prevent this from happening. As a result of asthma, the mass of bronchial smooth muscle becomes enlarged leading to bronchospasm. Using the nebulizer to suppress chemical mediators and nerves from constricting the muscles in the bronchial tubes will therefore bring an end to this pathological process Avoid any contacts with allergen and other irritants as much as possible       This intervention is necessary because inflammation will naturally occur as a response to allergen and irritants (Rebuck and Read, 2003).   As part of the pathological process, there is bronchial vessel dilation resulting from inflammation (Christopher, Wood, Eckert, et al. , 2003).

This intervention will therefore stop inflammation and thus prevent this pathological process.   Recommendations and Specifications for using the metered dose inhaler Once the patient has been discharged and using the metered dose inhaler as one of the interventions, it is important for the following to be ensured. The inhaler is to be shaken for 5 seconds with or without the spacer before it is used Use of index finger in releasing medication from the canister is preferred The inhaler should be held away from the face so that the medication does not get to the eye The injection is to be done three times Priming of the inhalation is necessary only after it has been unused for 2 weeks or more If possible, should be used under the supervision of a caregiver The inhaler must be with the patient at all times.

References

Agency for Healthcare Research and Quality (AHRQ) (2010). Care Transitions from Hospital to Home: IDEAL Discharge Planning. Implementation Handbook. Retrieved June 11, 2014, from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Implement_Hndbook_508_v2.pdf

Christopher K L, Wood R P, Eckert R C. et al. (2003). Vocal cord dysfunction presenting as asthma. N Engl J Med 19(4), 342-274.

Hart S. R. and Davidson A. C. (2009). Acute adult asthma: assessment of severity and management and comparison with British Thoracic Society Guidelines. Respir Med 10(10), 938-1102

Pearson M. G., Ryland I. & Harrison B D W. (2010). Comparison of the process of care of acute severe asthma in adults admitted to the hospital before and 1 yr after the publication of national guidelines. Respir Med 12(5), 545-565

Rebuck A S. and Read J. (2003). Assessment and management of severe asthma. Am J Med 8(2), 517-569

Windom H. H, Burgess C. D, Crane J. et al. (2011). The self‐administration of inhaled beta-agonist drugs during severe asthma. NZ Med J 34(4), 197.207

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