HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion

HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS Home > Humanities > HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion Question Description Help me study for my Social Science class. I’m stuck and don’t understand. As a human services professional, you must adhere to professional competencies in your chosen field (e.g., mental health, public health, counseling, or criminal justice). National competencies, such as the national license in mental health or national certification in human services, may be required and your employer may also require adherence to competencies. This means keeping up-to-date on new developments in your specialty area, certifications, and licensures. An area that will show aptitude in competency is in discharge planning of clients and patients from a program or facility. There are legal and ethical aspects of discharge planning, and referral of care is one that touches in these areas—specifically what and how information is shared. For this discussion, read article “Psychiatric Discharge Process” from the module resources. Then address the following in your initial post: Based on the Sample Discharge Plan document-attached, which is provided for a patient who is being discharged from a psychiatric facility for substance abuse crisis, critique the plan and indicate components that fall under PHI laws. Identify any aspects of the discharge plan that might be considered unethical. 200-250 words APA format, cite the article Unformatted Attachment Preview HSE 340 Sample Discharge Plan The Psychiatric Hospital 1111 Main Street Anywhere, USA 555-555-5555 Date of Exam: Time of Discharge Exam: 1/1/2015 3:15 pm Patient Name: Patient ID: Date of Birth: John Doe 10050049 2/15/1965 Date Admitted: Date Discharged: DISCHARGE PLAN 12/14/2014 1/1/2015 This discharge summary and plan includes: 1. Initial psychiatric assessment at admission 2. Treatment progress 3. Clinician’s narrative(s) 4. Discharge status and instructions Initial psychiatric assessment at admission completed on 12/14/2014 History: John Doe is a 49-year-old divorced man who presented at the emergency room with psychotic features, alcohol on his breath, and was on the verge of passing out. Mr. Doe was transported to this hospital after a two-day detoxification of alcohol intoxication and saying he “wants to die.” At the time of this assessment, Mr. Doe indicates the following: “I am always nervous and I can’t think straight. I drink sometimes because it helps me with anxiety. I get down a lot, and think about killing myself.” Mr. Doe arrived with medication of Ativan for anxiety and continued detoxification from alcohol dependence. Chief Complaint: Suicidality, anxiety, depression, and alcohol dependence Symptoms: • • • • Anxiety Depression, moderate to severe Irritability Difficulty concentrating Based on the risk of morbidity without treatment and Mr. Doe’s inferences to suicidality, functioning severity is estimated to be moderate. Past Psychiatric History Prior Psychiatric Disorder: Mr. Doe has a history of depression and alcohol dependence. He has suffered from depression since he was 25 years old. Outpatient Treatment: Mr. Doe has received medical treatment for depression by a family practitioner intermittently from 2001–2009. Suicidal/Self-Injurious: Mr. Doe was treated for an emergency on two prior occasions for suicidality. Substance Addiction/Use: Mr. Doe drinks alcohol regularly and is considered dependent. Psychotropic Medication History: Prozac has been prescribed for depression in the past. Not using currently. Past psychiatric history is positive for depression and alcohol dependence. Social/Developmental History: Mr. Doe is a divorced 49-year-old man. He is Native American. No religious affiliation. He does not live on a reservation. He has two children from one previous marriage. Employment History: Mr. Doe is a truck driver. Support System: Mr. Doe says he has his two adult children and one brother as his social support. His brother lives in a nearby state, and is not local, but his children live in the same town. Strengths/Assets: Mrs. Doe is articulate and verbal. Patient’s Goals: “I want to feel better and not be so depressed that I want to die.” Family History: Mother had depression, but unknown if treated Alcohol abuse on father’s side Medical History: Allergies: None Current Medical Diagnoses: 1) Cirrhosis of liver, mild; 2) diabetes, untreated at time of admission Brief Hospital Course: Patient was tapered off of the Ativan given from the emergency room admission. HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion Patient was started on Cymbalta, 60 mg, once daily. Laboratory tests revealed diabetes, mild, and can be controlled with diet and exercise. Patient attended group and individual therapy sessions twice weekly during hospital stay. Patient was given contact information for a local AA group, and he indicated he made contact. Patient has made progress with decrease in depressive state and denies suicidality the last week of treatment. Condition at Discharge: Mr. Doe stated he wished to be discharged in order to go home and get back to work. At the time of discharge he stated he is not suicidal and plans to seek AA support for his alcohol addiction issues. He has the following appointments set up post discharge: Mental health treatment: Weekly outpatient psychotherapy with substance abuse counselor Medication Follow up: Appointment set with primary care doctor for refills of Cymbalta, beginning with 90 mg one week post-discharge. Recommend diabetes follow-up. Discharge Psychiatric Diagnoses: 1) Major depression, without psychotic features 2) Addiction disorder, alcohol Medications at Discharge: Cymbalta 60 mg once daily Medication Instructions: Patient should continue with current medications and follow up with primary care provider with increase to 90 mg, one post discharge. Consent: Patient was advised regarding risks and benefits of treatment. Physical Activity: No limits Dietary Instructions: Follow up with primary care provider for diabetes and proper diet Other Instructions: Mr. Doe was advised to call treating physician if symptoms recur Emergency Contact: 555-55-5555 Notes and Risk Factors: None noted John Smith, MD Electronically signed On: 1/1/2015 3:20 pm International Scholarly Research Network ISRN Psychiatry Volume 2012, Article ID 638943, 7 pages doi:10.5402/2012/638943 Review Article Psychiatric Discharge Process Hamzah M. Alghzawi Faculty of Nursing, The Al-Albayt University, Mafraq 130040, Jordan Correspondence should be addressed to Hamzah M. Alghzawi, [email protected] Received 1 May 2012; Accepted 3 July 2012 Academic Editors: B. J. Mitterauer and D. Wolde-Giorgis Copyright © 2012 Hamzah M. Alghzawi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate di?erent levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more e?ective. Depending on this review, it could be concluded that e?ective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage. 1. Introduction Discharge planning is a vital process in nursing field. Discharge planning could be defined as a dynamic, comprehensive, and collaborative process that should be started at the time of admission and its purpose is to identify the client’s plans and the support which the client and caregiver would require after existing from psychiatric unit [1]. In the health care field “discharge planning” is one of the most important issues in our time, it is at once a methodology, a discipline, a function, a movement, and a solution [2]. 2. Significance and Purpose of the Paper By increased pressures for rapid discharge of psychiatric patients as a result of various government cost containment strategies, it is essential that a comprehensive discharge planning process be established in psychiatric facilities [2]. Discharge planning is widely considered as a necessary component in the community care of the chronic mentally ill. The new trends of deinstitutionalization were started with no comprehensive planning for adequate or appropriate community resources [3], this means that discharge planning must be creative. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. So, what is the meaning of psychiatric discharge planning, what is the importance of discharge planning, who is involved in psychiatric discharge planning, what are the considerations discharge planning based on, and does e?ective psychiatric discharge planning prevent readmission to inpatient psychiatric units? Answers for these questions and others will be searched in the literature. 2 3. Methodology 3.1. Search Strategy. All levels of evidence as defined by the NHMRC (2000) were searched, the search strategy aimed to locate di?erent study designs such as systematic reviews and meta-analyses, randomized controlled trials, controlled trials, cohort or case-control analytic studies, expert opinion including literature/narrative reviews, consensus statements, descriptive studies, and individual case studies. 3.2. Key Search Words. Clients, psychiatric unit, mental health unit, acute, discharge, discharge plan, discharge process, and prevention of readmission. 3.3. Inclusion/Exclusion Criteria. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards (assessment on admission, inpatient assessment, preparation of individualized discharge plan, provision of interventions, monitoring), and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multifaceted intervention and was not the main focus of the paper. 4. Literature Review Discharge planning is an important step in order to maintain gains achieved during the course of treatment that the clients have in the inpatient psychiatric unit. On the other hand, lack of discharge planning can cause the disturbance in the care of the client which is considered as one of the most significant obstacles to establishing a stable recovery [4]. HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion The client after discharge may still be in need of selfhelp groups, relapse prevention groups, continued individual counseling, and mental health services especially important for clients who will continue to require medication, as well as intensive case management monitoring and support [5]. So, a carefully developed discharge plan, produced in collaboration with the client, will identify and match client needs with community resources, providing the support needed to sustain the progress achieved during treatment. Numerous concepts that could be used to improve the e?ectiveness of discharge planning became apparent. First, because there are usually multiple health providers for a single patient, continuity of care can be achieved only by interventions to establish personal and specific linkages between the discharging facility and the aftercare provider [6]. Second, to ensure the relevancy of the referral to outpatient care setting, inpatient treatment should include the coordination of community services that are matched to the patient’s level of functioning [6]. Third, “nonpsychiatric obstacles,” such as housing, employment, and need for supplemental security income, that serve as di?cult barriers to e?ective planning must be dealt with [7]. And, finally, the discharge plan must be integrated into the treatment process in such a way that the patient is o?ered the chance to become ISRN Psychiatry an active participant in the plan and thus is more likely to accept it [6]. Health providers in the community support system noted that many of the patients who were resistant to aftercare services were those for whom discharge planning came late during their hospitalization, or for whom plans were not integrated into the treatment process; however, plans were made early [6]. Moore [8] conducted a study about discharge from an acute psychiatric ward. This descriptive study aimed to find out whether “discharge is planned to support improvement of symptoms and prevent future readmissions.” However, little information is given about how the study was carried out. It was found an improvement in patient symptom during admission. Cohen et al. [9] conducted a study to examine the factors that influence the inpatient team’s ability to secure a “good enough” fit between the patient’s needs and an optimal discharge plan. 494 consecutive admissions had the Mount Sinai Discharge Planning Inventory completed weekly during admission. Discharge planning was able to have greater impact in the areas of increase daily activities and establishing relevant treatment options. Assisting patients to find a more suitable living arrangement was an area that discharge planners had greater di?culty with. The authors advocate the Discharge Planning Inventory as a tool to track progress and evaluate discharge planning. It is stated that the optimal first choice discharge plan was “identified by a consensus among professional clinician’s based upon patient’s needs” [9, page 520]. This implies that there was little input from patients in identifying their own needs for discharge. Similarly the Discharge Planning Inventory was completed by a social worker with apparently little input from patients. Another study by Caton and associates [10] showed that the quality of discharge planning was predictive of rehospitalization within three months when the patient’s prognosis was taken into account. Also, Caton and Gralnick [11] reviewed the literature about the factors which a?ect length of psychiatric hospitalization and concluded that rather than diagnosis itself, other environmental and delivery systems factors together may have predictive ability [12]. Access to environmental supports is felt to significantly influence recovery from psychiatric illness [13]. Really, such factors as housing and placement considerations, level of social competence or functioning, severity of psychiatric condition, and adequacy of social supports have been reported to contribute to the length of inpatient stay [14]. Furthermore, family involvement, continuity of care, psychosocial rehabilitation, psychoeducation, selection of appropriate medications, and patient cooperation have been identified as factors contributing to after discharge recovery [15]. Rock [16] described the Expert viewpoint about the essential elements in providing quality discharge planning services. He recommended that discharge planning must be a collaborative e?ort including all clinical departments. Also, Discharge planning process need to be supported by e?ective posthospital support programs. ISRN Psychiatry Altman [6] examined the use of collaborative discharge planning (CDP) meetings for patients with chronic mental illness patients. HSE 340 SNHU Professional Competencies Psychiatric Discharge Discussion A higher percentage of patients who were involved in collaborative discharge planning became involved in aftercare services compared to those who were not involved in CDP. A collaborative process between hospital sta?, the patient, the family, and community agencies lead to advocates discharge planning. But in this study little demographic information is given about the 2 compared groups or how patients were allocated to the groups. Also sample is relatively small (29 patients). Ledbetter and Batey [17] described a resource group model. This service user education model was used in a small group setting to provide information about medications, community resources, and vocational rehabilitation services. The authors propose that this model encourages involvement of clients in discharge planning, facilitation of interpersonal skills, and integration of services. This was an interesting outline of group work in an inpatient setting but was limited in the discussion and analysis of outcomes. Kelly et al. [18] examined factors in delays in discharge from acute-care psychiatry and threw a survey of 327 patients from 12 psychiatry units. It included the use of the Brief Psychiatric Rating Scale (BPRS) and the Discharge Readiness Inventory (DRI). There was followup at 30 days to determine discharge outcome. Both the BPRS and the DRI were altered for use in this study, which may have a?ected the reliability and validity of the instruments. In this study, a proportion of patients who were (clinically) ready for discharge were not discharged due to ongoing behavior and medication stabilization and lack of community resources such as housing. This means that improving access to residential placement would reduce length of stay for some patients. Also, Patients whose discharge was delayed were found to have higher levels of conceptual disorganization, hallucinations, disorientation, and more active symptoms. These patients could be targeted for early intervention and early discharge planning. Giving perception of discharge from the perspective of the sta? members completing the survey was identified and discussed in this study as clinical implications and limitations. Buckwalter [19] described methods that should be used in predischarge planning programs to assist patients “take charge of their illness and become partners in the treatment process” (page 15) and reduce likelihood of readmission. The main components that should be considered in discharge planning according to the researcher are working with the patients’ family, giving the patient simple and accurate literature to read about their illness, assisting patients to understand what their diagnosis means, assigning homework that requires the patient and family to read instructional material between appointments, assisting patients in looking at their stressors and exploring stress management techniques, assisting patients to recognize the meaning of their symptoms, assisting patients to develop ways of explaining their hospitalization when discharged, encouragement to continue with recreational activity, and education about medication and encouragement of compliance. However these methods appear e?ective, they reflected the opinion 3 of two clinicians from one discipline and so may be a limited representation of the issues related to discharge planning. Caton et al. [10] studied the impact of discharge planning on chronic schizophrenic patients. This study conducted on 114 patients with chronic schizophrenia at 4 inpatient psychiatric units. The discharge planning schedule was developed for this study and involved interviewing patients, sta? and family. The community care schedule was then administered to patients three months after discharge. A study of the interrater reliability of the discharge planning schedule and the community care schedule was carried out. The adequacy of discharge planning bore no significant relationship to role functioning, daily activities, social isolation, or employment at 3 months after discharge. Patients who had adequate discharge planning for vocational issues were not more likely to attend vocational rehabilitation or participate in the labour force. Patients who received adequate discharge planning for aftercare services were more likely to comply with aftercare treatment and were less likely to be readmitted. Discharge planning for living arrangements was based on what was available and the patient’s financial resources rather than on what might have been most desirable for successful community living. The literature review on the information needed at dischar … Purchase answer to see full attachment Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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