admission discharge

2. Introduction
 Admission to a hospital can be a traumatic experience
with anxiety and fear for anyone. The nurse is one of
the most important person that meets client in
hospital.
The duration and severity of illness influence his /her
reaction to admission procedure.

3. Definition
 Admission is defined as allowing a patient to stay in
hospital for observation ,investigation ,treatment and
care.
 Admission is the entry of a patient into a hospital
/ward for therapeutic /diagnostic purposes.

4. Purposes
 To receive the patient in the ward for admission
according to his condition.
 To provide comfort and safety to the patient.
 To provide immediate care.
 To be ready for any emergency.
 To assist patient in adjusting to hospital environment.
 To acquire vital information regarding the patient.
 Asses the patient from which a nursing care plan can
be initiated.

5.  To obtain information about patient such as address,
guardian and any other information that will serve as
a basis of care.
 To establish a nurse –patient relationship.

6. Principles
 Sudden change or strangeness on the environment will
cause fear and anxiety.
 Entering the hospital is a threat to one’s personal
identity.
 People have diversity of habits and behaviours.
 Illness can be traumatic experience for the patient and
bring stress on his physical and mental health.

7. General Instructions
 To receive the patient and help him to adjust to
hospital environment.
 To welcome and establish a positive initial relationship
with patient and relatives.
 To obtain needed identifying data concerning the
patient.
 To provide immediate care ,safety and comfort.
 To collaborate with patient in planning and providing
comprehensive care.

8.  To observe and report signs and symptoms and general
condition of patient.
 To secure safety of the patient and his belongings.
 To maintain the privacy of patient.
 To handover the jewellery valuable to the client’s close
person. In case the client is minor or unconscious,
keep it in nurse’s custody with two witness.

9. Types of admission
 1.Emergency admission:
 In this ,patients are admitted in acute conditions
requiring immediate treatment.
 e.g patient with accidents ,
 Poisoning,
 Burns and heart attack.

10.  2.Routine admission :
 In this ,patients are admitted for investigation and
medical or surgical treatment.
 Treatment is given according to patient’s problem.
 e.g.patient’s with hypertension ,diabetes,and
bronchitis,cholecystectomy.

11. Preparation of articles for
admitting the patient
Articles:
All articles for an open bed-
bottom sheet, mackintosh,
draw sheet, top sheet ,blanket.
Rationale:
To keep the bed ready to
receive the patient in a calm
manner.
Other articles require for daily
care of patient e.g temperature
tray, sponge bath tray,a set of
hospital clothes.
sphygmomanometer ,
stethoscope.
To be ready to give care to the
patient.It can save time and
energy for the nurse.
Any other special equipments such as
oxygen mask and cylinder, suction
machine,cardiac monitor,emergency
To meet emergency needs in life saving
situations.

12. PROCEDURE OF ADMISSION

14. Steps:
1.Prepare the room with care
and arrange all items in place
and adjust height of the bed.
Rationale:
To feel safe and secure and
easy transfer from stretcher to
bed.
2.Check the client’s
identification and greet him /her
and relatives. Introduce yourself.
To help them to feel at ease and
provide room for care of the
client.
3.Observe the client’s vital signs
and symptoms and collect
specimen for lab test if required.
To know condition of patient on
admission. To assist the
physician in line of treatment.

15. 4.Provide privacy .Give
admission bath, if needed.
To make patient comfortable.
5.Explain the bathroom and other
equipments in the room or ward.
Place a locker and call bell in easy
each of the patient.
Explain meal timings and
visiting hours to client and
elatives.
To help the client to be ease and
knowing how to use equipment to
prevent accidents.

16. 6.Answer queries of clients and
elatives.
Helps to relieve anxiety and
fear.
7.Complete necessary records
according to a hospital policy
which includes nursing history
and assessment.
It serves as a proof.

17. Unit and It’s preparation
 Unit: It is a place where the patient is kept during
hospital stay.
 The admitting department notifies the unit prior to
the patient’s arrival so that room/bed can be prepared.
 Special considerations: Some of the activities
carried out by nurse before the patient is to be
admitted are:
 1.Keeping the bed ready: Open the bed, fold back the
bed spread, top blanket and top sheet.

19.  2.Position the bed: For ambulatory client ,bed should
be in normal position.If the client has to arrive on a
stretcher ,bed should be in in lowest position.Make
sure that furniture in room has been arranged to
ensure easy access to the bed.
 3.Assemble necessary equipments and supplies:
 A hospital admission pack, which contains items
such as bath basin, drinking glass,thermometer,papers
and lotion .

20.  4.Assemble special special equipment and
supplies:
 The client may require oxygen therapy, cardiac
monitoring or suction equipment.
 The nurse should make sure that equipment is
functioning properly and is ready for patient’s use on
his /her arrival.

22. ROLES AND RESPONSIILITIES OF A
NURSE
 1.Nurse should make every effort to be friendly and
courteous with the patient.
 2.Facilitate admission to patients in a care setting to
provide nursing care.
 3.Make proper observation of patient’s condition.
 4.Assess and evaluate patient’s health for nursing care.

23.  5.Orient patient and relatives to hospital policies.
 6.Develop healthcare nursing plans in coordination
with the clinicians or doctors.
 7.Observe policies in dealing with medico –legal cases.
 8.Nurse should recognize the various needs of the
patient and meet them without delay.

24.  9.Nurse should find out likes and dislikes of patient
and include patient in his plan of care.
 10.Nurse should address the patient by their name and
proper title.
 11.patient’s valuables and clothes should be handed
over to relatives with proper recording.

25.  12.Coordinate with other nursing staff and healthcare
team to provide nursing care.
 13.Ensure safe and compasssionate nursing care to
patients.
 14.Interact with patients and their families in
providing health and nursing care.
 15.Provide post surgical care to patients.

26.  16.Provide nursing care to patients in their home.
 17.Ensure compliance of admission nurse activities
with the standards of quality health care.
 18.Deal with patients very carefully who are suffering
from communicable diseases. Isolate if necessary.

27. DISCHARGE
 Discharge Planning/Preparation:
 Nurse is responsible for ensuring that the patient is to
be discharged.
 Discharge from the hospital should never come
unexpectedly to patients or to any of those attending
them.
 His discharge should be planned from the time of his
admission and he should be informed sufficiently early
of the day he can leave the hospital.

28.  Physical considerations:
 Physical interventions for the inpatient with
impaired activity include direct physical care related to
patient’s health problems for e.g. Occupational
therapy is one type of physical intervention that
prepares the patient for returning home with disability
that limits his activities of daily life.
 The nurse’s role is to reinforce, what the patient has
learned in occupational therapy.

29.  The nurse may recommend changes in the home base
on a home assessment done by interviewing the
patient or by visiting the home.
 Common physical changes include installing ramps
and handrails, moving furniture to make room for
rented hospital bed or installing equipment such as
oxygen tanks and suction machines.
 If a severely disabled patient is expected to return
home,a home visit should be made before discharge.
Patient with knee replacement ,need to make lot of
changes in home.

30.  Psycho –cognitive consideration:
 Psychological interventions are designed to meet
educational ,psychological and coping goals.
 Topics to be included in pre –discharge teaching are
whom to call for help and when ,self care (such as
wound care) and health maintenance topics
appropriate for the patient’s specific health problems.

31. Anticipatory guidance is information given about a
situation occurs so that the patient can develop
problem –solving and coping strategies.
For e.g.immediate treatment of heart attack to heart
patients.

32.  FAMILY CONSIDERATION:
 Social and family interventions are developed to meet
social support and resourse goals. Referrals may be
made to social workers and the discharge planner.
 A patient may develop a fear of going home, especially
if he/she lives alone or feels isolated, involving social
support in care is an important nursing intervention.
 Educating the family ,another nursing interventions
can be given before the patient is discharge.

33.  ETHICAL CONSIDERATION:
 In planning home care for a patient with impaired
activity, four ethical considerations are :
 1,Respect
 2,Beneficence
 3,Justice
 4,Fidelity(faithfulness to a person)

34.  HOME CARE:
 Before the discharge of patients ,the nurse must
consider family and social support ,the home
environment and the patient’s condition.
 Home health care is defined as “All the services and
products that maintain ,restore or promote physical,
mental and emotional health that provided to patients
in their homes.

35. DISCHARGE OF THE PATIENT:
 Patient is prepared for discharge when he is admitted
in the hospital .
 should be prepared physically and psychologically to
leave the hospital ward and his/her willingness to
leave certain activities is also very important .
 For e.g.salt restriction to heart patient.

36. TYPES OF DISCHARGE:
 Patient is discharged from the ward as follows:
 1.Cured and discharged:
 When the treatment of client is completed from the
hospital. He is discharge. He gets discharge after
Doctor’s order.
 2.LAMA(leave against medical advise):
 When the client does not want to continue his
treatment and want to leave against doctor’s medical
advice, patient is gone with LAMA. Here the risk and
complications are explained very well to client/his
family members.

37.  3.Absconded:
 When client leave hospital without any information to
hospital authorities. During the treatment process,
client leave the hospital without clearing his dues.
 4.DOR (discharge on Request):
 When client is not willing to take treatment from
hospital. On his personal request .Doctor gives
discharge order while describing his condition.

38.  5.Transferred to other hospital:
 Here patient is referred to other hospital where his
medical treatment can be continued because of
better/specialized services. For e.g. Client admitted
with cancer is referred to cancer hospital .
 6.Relieved:
 From hospital treatment is over.
 7.Death:
 When client with critical health problems is admitted
and not recovered ,died in the hospital.

39. STEPS FOR DISCHARGING A
PATIENT
 1.Make sure that there is written consent /instruction
for discharge and follow-up description.
 2.Make sure that family and the patient understand
the instruction for care (i.e. diet, medication, activity
exercises)
 3.If the patient or relatives decides to leave the hospital
against advice of his doctor ,have him sign LAMA.
 4.Assist the patient to dress, check and pack
belongings .

40.  5.Collect the discharge slip and prescriptions that the
patient is to take with him for follow –up care.
 6.Complete the patient’s record and discharge
summary.
 7.Transport the patient and his belongings via a wheel
chair. Assist the patient in to vehicle.
 8.Care of the unit after discharge.

41. DISCHARGE PROCEDURE
 1.No patient should be discharged without the doctor’s
written order. The physician writes on the patient’s
chart when the patient is to be discharged.
 2.Instructions regarding further care ,medication
,treatment ,follow up etc. should be clearly written and
interpreted to the patient and his family members.
 3.Provide the patient with medications or direct him to
purchase what is needed for him.

42.  4.Patient’s personal belongings such as clothing's
,money, and other valuables which were entrusted to
the hospital personal at the time of admission should
be checked and returned to him.
 5.Any of the hospital property that was given to the
patient for his use in the hospital should be checked
and received back before he leaves.
 The articles in the patient’s unit should be checked
and see that they are complete ,including the bed
linen.

43.  6.Before the patient leaves the hospital ,the nurse
should confirm whether he has paid all the hospital
bills.
 7.See that the patient is ready to go home, recently
bathed,hair combed and dressed in clean clothes.
 8.If the patient is not able to walk or not allowed to
walk to the conveyance, the nurse should see that he is
safely transferred either on a wheel chair or on
stretcher. see that a hospital attendant accompanies
the patient up to the front door, if possible.

44.  9.the dietary department should be informed of the
patient’s discharge.
 10.If any patient leaves the hospital against medical
advice he should be asked to sign a release form.
 The form should state that patient is leaving against
the advice of doctor and that neither the doctor nor
the hospital can’t be held responsible for any ill-effect
happening after his departure.
 This form should be filled with the patient’s record.
 11.the nurse should see that the charts are completed
and sent to the office or to the record section.

45. CARE OF THE UNIT AFTER
DISCHARGE PLANNING PROCESS
 After the patient is discharged and before admitting
another patient ,the room is cleaned and aired.
 Windows and doors are opened.
 The doors, windows,furniture are washed and cleaned.
 All the articles used by the patient should be taken to
the utility room ,washed, cleaned, sterilized if
necessary or disinfected by chemicals.
 These are rearranged and kept ready for next use.

46.  All unwanted things are discarded.
 Used linen are sent to laundry.
 Mattress, pillows, blankets etc. Should be exposed to
the sunlight, and then the bed is remade with fresh
linen.
 If the room was used by the patient with
communicable disease,it should be fumigate along
with the articles use by the patient.