Level of Evidence assignment
Concordia University, St. Paul
NUP 353: Nursing Role In The Acute Care Setting
Diane Holland, Patriek Mistiaen, and Kathryn Bowles' Problems and Unmet Needs of Patients
Discharged "Home to Self-Care" (2011) is a cohort study that aims to identify if patients who are
discharged from the hospital experienced problems and unmet needs after they returned home. The
authors used a study questionnaire administered via phone or mail after the patients went home from the
hospital to obtain their data. The results found that the majority of the participants found at least one
activity or item they had difficulty with after being discharged home. More specifically, patients reported
that they did not feel like they received enough information on their medications' side effects, at-home
pain management was lacking, not knowing how to get in-home care, and not being able to perform self-
hygiene activities (Holland et al., 2011). The study found flaws in the discharge planning process that can
easily be fixed with nursing interventions.
The study's findings showed that there are implications for practice at the patient level and the
facility level. At the patient level, nursing implications would include giving patient education on
medication side effects, at-home pain management, and how to get in-home care if needed. I think that the
problem isn't that nurses and healthcare staff aren't providing patient education, it is the timing of the
nurses education. A study done by Hari and Rosenzweig (2012) found that if nurses could optimize when
they did patient teaching, there would be a better outcome for patient retention than if it was done last
minute as they were being rushed to discharge. The study found that before surgery or the sooner you
begin education, the better, and nurses need to assess that the patient has retained the information by using
the teach-back method. If the patient forgets things, the nurse can reeducate on missed topics.
At the facility level, this study brings awareness to the hospital or health care facility that patient
needs aren't being met. When patients are leaving the hospital and don't feel like they've received
adequate information on medications, pain management, or any other unanswered questions they may
have, it can lead to readmission of the patient. The study found that a standardized screening tool to
identify which patients need post-acute care and who needs a discharge planner. These combined
interventions will result in better patient outcomes and patient satisfaction.
Discharge planning from hospital is a meta-analysis written by Goncalves-Bradley et al. (2016)
analyses the effectiveness of discharge planning on a patient's length of stay, cost of stay, and patient and
HCP satisfaction. The study found that starting discharge planning upon admission showed a slight
decrease in the length of stay needed. It showed there was an increase in patient and health care
professional satisfaction when discharge planning started sooner but, due to inconsistent findings, there
was little evidence to show with certainty that this is true. Finally, there was not enough