Chin-Yen Han

Discharge Planning in the Emergency Department: A Comprehensive Approach

Discharge planning has become increasingly important, with current trends toward shorter hospital stays, increased health care costs, and more community-based health services. Effective discharge planning ensures the safety and ongoing care for patients,1 and it also benefits health care providers and organizations. It results in shorter hospital stays, fewer readmissions, higher access rates to post-hospitalization services, greater patient satisfaction with the discharge, and improved quality of life and continuity of care.[2] and [3] All acute care patients and their caregivers require some degree of preparation for discharge home—education about their health status, risks, and treatment; help setting health goals and maintaining a good level of self-care; information about community resources; and follow-up appointments and referrals to appropriate community health providers. Inadequate preparation exposes the patient to unnecessary risks of recurrence or complications of the acute complaint, neglect of nonacute comorbidities, mismanagement and side effects of medication, disruption of family and social life, emotional distress, and financial loss.[2], [3] and [4] The result may be re-presentation to the emergency department. It is noteworthy that up to 18% of ED presentations are revisits within 72 hours of the original visit5; many of these are considered preventable.6 It is a primary responsibility of nurses to ensure that patients return to the community adequately prepared and with appropriate support in place. Up to 65% of ED patients are discharged home from the emergency department,7 and the characteristics of the emergency department and its patient population make the provision of a high standard of discharge planning uniquely difficult. In addition, discharge planning is neglected in contemporary emergency nursing—there are no monographs devoted to the subject, and there is little published research. In this article 3 issues are explored: the importance of emergency nurses’ participation in the discharge-planning process, impediments to their participation; and strategies to improve discharge planning in the emergency department.

Psychometric testing of the properties of the spiritual health scale short form

AIMS AND OBJECTIVES To further examine the psychometric properties of the spiritual health scale short form, including its reliability and validity. BACKGROUND Spirituality is one of the main factors associated with good health outcomes. A reliable and valid instrument to measure spirituality is essential to identify the spiritual needs of an individual and to evaluate the effect of spiritual care. DESIGN A cross-sectional study design was used. METHODS The study was conducted in six nursing schools in northern, central and southern Taiwan. The inclusion criterion for participants was nursing students with clinical practice experience. Initially, 1141 participants were recruited for the study, but 67 were absent and 48 did not complete the questionnaires. A total of 1026 participants were finally recruited, indicating a response rate of 89·9%. The psychometric testing of the spiritual health scale short form included construct validity with confirmatory factor analysis, known-group validity and internal consistency reliability. RESULTS The results of the confirmatory factor analysis supported the five-factor model as an acceptable model fit. In the known-group validity, the results indicated that people who are in the category of primary religious affiliation have better spiritual health than people in the category of secondary religious affiliation and atheism. The result also indicated that the 24-item spiritual health scale short form achieved an acceptable internal consistency coefficient. CONCLUSIONS The findings suggest that the spiritual health scale short form is a valid and reliable instrument for the appraisal of individual spiritual health. RELEVANCE TO CLINICAL PRACTICE The spiritual health scale short form could provide useful information to guide clinical practice in assessing and managing peoples spiritual health in Taiwan.

Exploring the Perceptions of Core Values of Nursing in Taiwanese Nursing Students at the Baccalaureate Level.

Background: The core values of nursing are a standard component of the nursing curriculum in Taiwan. Therefore, these values provide an essential guide for educating and evaluating the learning outcomes of nursing students. Student perceptions of those core values that relate to the process of curricula learning are key to measuring the core values of nursing. Purpose: This study explores the views on the core values of nursing of baccalaureate-level nursing students at a Taiwanese university. Methods: This qualitative study collected data from the reflection reports of 109 students and analyzed these data using thematic content analysis. Results: The results of this study identified that the learning of core values of nursing tends to utilize the latent curriculum rather than the open curriculum. Critical thinking was perceived and experienced by asking “why.” General clinical skills and basic biomedical science were categorized collectively as care ability, which relates to the thinking, analysis, and mapping of client health problems. The value of communication and teamwork capability was defined as the sequential process of accepting, interacting, communicating, and collaborating. Caring was defined as contributing empathy with respect to one’s self and to others. Ethics was defined as a moral perspective, as respecting others, and as prioritizing the needs of clients. Accountability was defined as a way of observing standards within the role given in a position. Finally, lifelong learning is a process of learning that encourages more aggressive learning. Conclusions/Implications for Practice: The progress of core values of nursing in this study reflects positive movement and achievement. The participants expressed the perception that the core values of nursing enhance understanding, which enables nursing educators to reframe the nursing curriculum to meet their learning needs. The perceptions of nursing students of core values of nursing may be used as a guide to increase clinical nursing competence in healthcare.

The emergency patient's participation in medical decision‐making

AIMS AND OBJECTIVES The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. BACKGROUND Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. DESIGN This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. METHODS Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. RESULTS The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. CONCLUSIONS The findings fill a gap in knowledge about the decision-making process among emergency patients. RELEVANCE TO CLINICAL PRACTICE The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses

Triage classifies and prioritizes patients’ care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses’ decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients’ health status, and nurses’ experiences. This study suggests ensuring the patient’s privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public’s understanding of the ED visits. These will make ED triage more efficient.

Registered Nurses and Discharge Planning in a Taiwanese ED A Neglected Issue

Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses’ perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents’ and relatives’ attitudes were barriers to implementing discharge teaching in the ED.

Professional resilience among nurses working in an overcrowded emergency department in Taiwan

PURPOSE Professional resilience has become increasingly important for nurses in adverse work environments to reduce the negative results and increase the positive outcomes of stress. This study aimed to explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) and increase knowledge about what nurses identified as protective factors, which may be useful for future planning. METHODS A construction-grounded theory (CGT) approach was adopted. Purposive sampling and snowball technique were employed to recruit 13 participants, which proved sufficient to achieve theoretical saturation. In-depth interviews were conducted and audiotaped. RESULTS Doubting work value and maintaining optimism were the 2 main themes in the core category of seeing and taking work difficulty and responsibility. Nurses described how their passion for their profession gradually diminished, but they assessed the situation and took responsibility for their jobs. CONCLUSION This study found that nurses retain their compassion, which sustains them in their work. The issue of ED overcrowding led to pessimism among nurses. However, work rewards encouraged nurses to adopt a more proactive attitude toward work-related adversity.

A study on the reporting intention of medical incidents: a nursing perspective

Medical incidents threaten patients’ lives and health, increase medical costs, and can lead to medical disputes. A high proportion of medical incidents are not reported. The aim of this study was to explore the factors influencing nurses’ reporting of medical incidents. The cross-sectional survey design used a self-administered 47-item questionnaire to survey 835 nurses in three hospitals in Taiwan between January and December 2014. The intention among nurses to report medical incidents was high (3.86/5); nurses’ intention to report medical incidents was positively correlated (r = .34, p < .0001) with their attitude about reporting, awareness of reporting (r = .37, p < .0001), and support from interested parties (r = .12, p = .001), and was negatively correlated with positive incentives (r = -.14, p < .0001) and negative incentives (r = .29, p < .0001). Nurses’ awareness and a supportive work environment affect nurses’ willingness to voluntarily report medical incidents; hence, they are critical considerations as Taiwan moves toward systems of mandatory reporting.

Elders’ Experiences During Return Visits to the Emergency Department: A Phenomenographic Study in Taiwan

Background Elders often experience multiple chronic diseases associated with frequent early return visits to emergency departments (EDs). There is limited knowledge of the experiences and concerns of elders during ED return visits. Objectives The purpose of the research was to explore the experiences of elders during ED return visits, with a view toward identifying factors that contribute to return visits. Methods The qualitative approach of phenomenography was used. Data were collected at one ED in a 3,000-bed medical center in Taiwan. Inclusion criteria were aged 65 or above and return visits to the ED within 72 hours of discharge from an index ED visit. The seven steps of qualitative data analysis for a phenomenographic study were employed to develop understanding of participants’ experiences. Results Thirty return-visit elders were interviewed in 2014. Four categories of description were established from the participants’ accounts. These were “being tricked by ED staff,” “doctor shopping,” “a sign of impending death,” and “feeling fatalistic.” The outcome space of elders with early return visits to ED was characterized as “seeking the answer.” Conclusion Index ED visits are linked to return visits for Taiwanese elders through physiological, psychological, and social factors.