涉外护理英语unit8MakingDischargePlanning.ppt

涉外 护理英语,Unit 8 Making Discharge Planning,对外经济贸易大学出版社,UNIT 8 Admitting a Patient,Attending the ward team meeting Referring a patient by telephone Explaining the effects of a stroke Using patient discharge planning forms Giving an oral report of the case,Description,Discharge planning is a process that improves client outcomes by predetermining his/her postdischarge needs in a timely manner and coordinating the use of appropriate community resources to provide a continuum of care. If effective, discharge planning shortens the hospital stay, decreases the cost of in-hospital care, reduces the necessity for readmission, and eases transition between the hospital and the next level of care.,翻译,Description,单元描述 出院计划是指预先确定患者出院后的适时需要，协调使用适当的社区资源以提供连续的护理从而改进患者治疗效果的过程。如果出院准备服务有效，可以缩短住院时间，降低住院护理费用，减少重新住院的需要，使医院与下一级护理机构之间平衡过渡。,A discharge planner is a core member of a hospital patients care team. Working with the attending physician, specialists and bedside nurses, the discharge planner helps to coordinate the patients transition to life after the hospitaloften working with nursing homes, medical equipment providers and insurance companies to seamlessly facilitate a patients move to the next level of care. Discharge planners often join the daily rounds with the medical staff. In addition to rounding with physicians, the discharge planners will meet with patients and families to discuss placement options into nursing homes or assisted-care facilities, help organize medical records for transmittal to a rehab facility, provide advice on which durable medical equipment is most useful and negotiate with insurance companies. Sometimes, a discharge planner will overcome minor barriers, such as a lack of transportation from the hospital to home.,Work Description,翻译,翻译,Work Description,Most discharge planners are registered nurses or medical social workers. Larger hospitals require a minimum of a bachelors degree in nursing or a masters degree in social work. A good discharge planner needs to be highly organized, empathetic and capable of multitasking in a high-stress biomedical environment. Because families are often strained during hospitalizations, a good discharge planner will know how to handle difficult situations in a way that promotes the best outcomes for the patient while reducing the facilitys overall cost-to-care. In departments with a mix of nurses and social workers, a nurse may be assigned to deal with medically complex discharges (e.g., a major burn case) while social workers often get routine discharges or cases with financial or social barriers (e.g., a low-income patient who does not speak English).,出院计划者是医院病人护理团队中的核心成员。出院计划制订者协同主治医师、专科医生、床边护士帮助协调病人过渡到出院后的生活，通常和老人院、医疗设备供应商以及保险公司打交道使病人与下一级护理无缝对接。 出院计划制定者经常参加医护人员每日的查房。除了和内科医生一起查房外，出院计划制定者还和患者及其家庭成员一起讨论到疗养院或保健机构的安置问题，帮助整理转入康复机构的病历，提供使用耐用医疗设备的建议并与保险公司协商。有时出院计划制定者要帮助解决一些小困难，如没有可将病人送回家的交通工具。 大部分出院计划制定者是注册护士或医院社工。大型医院要求出院计划制定者具有护理本科学位或是社工硕士学位。 优秀的出院计划者需要有良好的组织能力，富有同情心，能够在高压生物医学环境中处理多个任务。由于家庭成员在患者住院期间通常处于紧张状态，优秀的出院计划制定者要知道如何处理困难情形，在减少机构总体护理费用的情况下，促进最佳治疗结果。在护士和社会工作者一起工作的部门里，护士会被安排处理复杂病情的出院（如大面积烧伤病例），而社会工作者则负责常规病情的出院或是处理有经济困难或社交障碍的病情（如不能讲英语的低收入患者）。,Work Description,Task 1 Taking a medical history of a patient,Discharge planning is an integral part of patient care and often involves the ward team meeting, a Multidisciplinary team attached to each unit (MDT). Multidisciplinary team (MDT) participation is essential to ensure the best outcome for the patient.,Description,翻译,出院准备服务是患者护理的一部分，它通常涉及病房团队会议和附属于每个科室的多学科治疗团队。要确保患者得到最好的治疗效果，多学科治疗团队的参与是必不可少的。,任务描述,Effective team meetings Team meetings must be focused on the patients needs. Each team member needs to contribute relevant patient information and share their expertise. Good housekeeping during meetings is essential for the smooth running of the session. Turn-taking, inviting all members to express an opinion and managing the agenda in a timely fashion are important, as are the avoidance of grandstanding and blocking behaviors. Teams which work well together often contribute to efficient co-ordination of services and a positive outcome for both patient and family. What is MDT? The MDT consists of healthcare workers such as physiotherapists, speech and language therapists, occupational therapists, doctors and nurses. If appropriate, psychologists and social workers may also be involved in the team.r next of kin.,翻译,Related Information,Certain barriers to effective teamwork may hinder the progress of discharge planning. One such barrier is the perception of teamwork held by the members of the team. Nowadays, nurses are regarded as equal partners in the healthcare team who share the workload of the team. A further barrier to good teamwork is the possession of insufficient skills to function as a team member. The MDT must be highly skilled in their areas of expertise in order to be able to contribute effectively to the group. Guidelines for MDT with stroke patients The aim of team meetings is to ensure that a liaison with community services is in place and services such as support groups are organized for the care givers of patients with a chronic illness such as stroke. This is important so that elderly patients can be supported in a return to their own home and readmission to the hospital is avoided because of coping supports at home.,翻译,Discharge planning of the elderly after a stroke commences on the day of admission as many services need to be booked prior to discharge. The assessment of a patients ability to return home takes into account residual damage after a period of rehabilitation after stroke. Time spent in rehabilitation is exhausting for stroke patients as they relearn many simple tasks such as feeding themselves, toileting and mobilizing. Intensive physiotherapy and occupational therapy are required, both during rehabilitation and afterwards on return home. A strong support network needs to be established before discharge that consists of family, a district nurse, a local doctor and a support group.,翻译,A、Hypothetical case for illustrating how the MDT works together to provide better care for the elderly.,有效的团队会议 团队会议必须集中关注患者的需求。每一个团队成员需要提供相关的患者信息并分享他们的专家建议。会议期间良好的内务管理是会议顺利进行的根本保证。话轮转换，邀请所有的成员表达观点并及时管理议程十分重要，因为它们避免了哗众取宠的行为和阻断行为。良好的团队通常能有效协调各种服务，为患者和家庭争取良好的治疗效果。 什么是MDT MDT，多学科治疗团队，由健康保健工作人员组成，主要有理疗医师、言语及语言障碍治疗师、职业理疗师、医师和护士。在适当情况下，心理学家和社会工作者也可能包括在这个团队中。 团队合作的效率障碍可能阻碍出院准备服务工作的进展。其中一个障碍就是团队成员对团队合作的看法。现如今，护士在健康照顾团体里被同等看待，分担了团队的工作负荷。另一个障碍就是团队成员技术不足，不能胜任。MDT成员必须在本专业领域游刃有余，必须具备为团队作出有效贡献的能力。,相关信息,中风患者的指南 团队会议的目的是确保与社区服务联系，且为照顾有慢性疾病如中风患者的护理人员安排支援团队，这一点很重要，这样年老的患者回到自己家里也能得到照料，因为家里有应对措施，也避免了再次入院。对年老者中风后的出院评估在入院当天就开始，因为很多服务需要出院前预定。患者回家能力的评估要考虑到中风康复期后的残留损伤。花在康复上的时间让中风患者精疲力竭，因为他们要重新学习很多简单的事情，如自己吃饭、如厕和活动。在康复期和返家后都需要物理治疗和职业治疗。患者出院前需要建立强大的支援网，由家庭成员、社区护士、当地医生和支援团队组成。 MDT是如何协作给老年患者提供高质量护理的案例,患者因严重的呼吸短促感觉不适来看全科医生。咨询了呼吸科医生，经过检查，患者被诊断为轻微的慢阻肺和轻微的心力衰竭。患者被转诊到心脏内科，并给以降压药、吸入器和家庭氧疗治疗。,邻居发现患者倒在地上，并主诉髋部痛。医务辅助人员送她到医院，医院护士和医生讨论她现在的病情和她的慢阻肺、心力衰竭病史。,医院医生查看了患者病史，检查了患者，然后与护士讨论使用止疼药和照骨盆X线的计划。X线理疗师评估患者的活动力，发现患者股骨颈骨折。安排骨科医疗队与患者讨论骨盆手术的需要和风险。她同意做手术。,术后，护理团队给药和监视每天的进展。不幸的是，患者手术期间中风了。护士和医生讨论了她的护理并成立了一个健康照顾团队以帮助护理患者。,语言障碍治疗师评估了患者的咀嚼和吞咽能力，这些能力有助于充分摄入。营养师评估了她的营养状况，改变了她的膳食结构，并指导患者摄入钙。同时，他们把患者的摄入写入患者的管理计划里。,理疗师评估患者的活动能力，讨论她的日常活动。她和患者一致认为患者要多锻炼。护士和医生讨论了她的建议，并将其纳入管理计划里。,社会工作者评估患者的心理社会状况和对帮助的需要，她了解到患者可以得到家庭和邻居的照顾。她报告和记录了她的发现，并向健康照顾工作者提出建议。,职业治疗师评估患者对适应性设备的需求，首先是在医院里对设备的需求，然后在家庭环境里对设备的需求。给患者适应性设备的目的是克服手指的不灵活从而促进独立生活能力。在家访期间，职业理疗师看到了未开封的药物，她通知了全科医生。,全科医生和患者讨论她不用药的原因，患者同意向药剂师征询进一步的建议。全科医生和药剂师合作与患者一起鼓励患者正确用药。,患者很高兴，感觉她的护理得到了很好的管理。她的心力衰竭和慢阻肺在门诊部得到跟进。,Discussion of the nursing topic,Most hospital wards have a weekly team meeting to discuss the progress of certain patients. The members of the team involved in the patients care meet to talk about care after discharge from the hospital, and plan any assistance which may be needed. How is the ward team meeting like? Team meetings must be focused on the patients needs. Each team member needs to contribute relevant patient information and share their expertise. Good housekeeping during meetings is essential for the smooth running of the session. Turn-taking, inviting all members to express an opinion and managing the agenda in a timely fashion are important, as are the avoidance of grandstanding and blocking behaviors.,2. What are the benefits of collaboration between healthcare professionals? It contributes to efficient co-ordination of services and a positive outcome for both patient and family. 3. What are some of the difficulties that might occur during team meetings? Certain barriers to effective teamwork may hinder the progress of discharge planning. One such barrier is the perception of teamwork held by the members of the team. Nowadays, nurses are regarded as equal partners in the healthcare team who share the workload of the team. A further barrier to good teamwork is the possession of insufficient skills to function as a team member.,Common patterns and questions when attending the ward team meeting,Lets start with. The purpose of this meeting is. William, do you want to start? I agree with both of you. Yes, Im a bit worried about that as well. Cindy, what about.?,Pracitce of the task,Most hospital wards have a weekly team meeting to discuss the progress of certain patients. The members of the team involved in the patients care meet to talk about care after discharge from the hospital, and plan any assistance which may be needed Lucy: Lets start with Lilia. Lilias a 75-year-old French lady whos been living in her own home for 30 years; shes a very independent woman. You might remember that her daughters had paid her a visit on a Sunday morning as usual and found her to be uncoordinated; um, she was having trouble picking up her cup of water. They noticed that she was slurring her speech as well. Lilia said shed had a “funny turn” the night before so, unfortunately, by the time they brought her to hospital it was well over the initial three hours from the onset of the stroke. Shes been with us for two weeks now and has been working really hard with everyone so that she can get back to her own homeThe purpose of this meeting is for us to report back on what weve all been doing for Lilia. Then we need to make a final decision on her discharge plan. Robert, do you want to kick off?,翻译,Robert: Mm, I examined her yesterday, and I feel that shes doing well, medically. Ive spoken to Lilia, and she seems keen on going home. She impressed me as a very independent person, too. I asked her about her goals and going home seems to be top of the list.,Lucy: Yes, shes spoken to me about how she was managing at home before the stroke. Her daughters are very supportive, too, which will be good. Shell need a lot of help with her ADLs. Cindy, how did you find her? Cindy: I agree with both of you. Shes been trying really hard. Shes been doing all the physio exercises I give her. Its just.Im a little concerned about her ability to perform the basic ADLs, especially showering, toileting, eating and mobility.,Robert: Yes, Im a bit worried about that as well. Um, why dont we have a look at the home assessment? Has the Occupational Therapist Team done a home assessment yet? Lucy: Not yet. Ive booked a home assessment with Occupational Therapy on Tuesday, 15th May. Thatll give us a better idea about the sort of adaptation which needs to be made for safety and to allow her to be as independent as possible.,Cindy: Good. Im pleased with her progress. The weakness on her left side has partially resolved. Unfortunately, shes still got a bit of trouble with vision loss on that side. Ive been training her to turn to the left to look for anything she might run into.,Lucy: Um, Lilias going to stay with her daughter, Lisa, until the safety modifications in the house are finished. Robert: Thats good. Chris, what about speech and language therapy? Hows she doing?,Chris: OK, well my role has been to help Lilias swallow reflex. Ive been concentrating on her swallowing problem and speech difficulties. Remember she had quite a lot of difficulty in swallowing when she first came in. Lucy: Yes, her nutritional status was quite poor. There was also the cultural part, too. She wasnt used to the food they serve in hospital. Chris: No, its very different from her usual diet. Her daughters helped out with this one. Theyve been bringing in the food that she likes. The kitchen staff has pureed it for her. She still has some tongue and lip weaknesses. Its quite hard for her to speak properly. Ive been practicing a lot of mouth exercises with her, and shes certainly improving. Shes always been a very social person, according to her daughters, so the ability to communicate is important to her.,Robert: Have you referred her for speech and language therapy after discharge? Chris: No, I havent referred her to a Speech Therapist yet. Thats part of the referral to the District Nurses. Lucy, youve organized that, havent you? Lucy: Not yet. I wanted to wait until after the team meeting. Ill ring this afternoon. So, can we put Lilias expected date of discharge down as Saturday, 19 May?,任务案例,（康复病房注册护士露西正在主持一个团队会议来讨论一位75岁的老人莉莉娅。她近期中风了。在医院经过一段时期的康复治疗后，准备出院。）,露西： 让我们以莉莉娅开始。莉莉娅是一位75岁法国女士，她一直居住在自己的家里30年了，是一位非常独立的女士。你可能记得，她的女儿们像往常一样于周日早上探望，发现她动作不协调，嗯，拿水喝都有困难。还注意到她说话也含糊不清。莉莉娅说她头一天晚上已经很奇怪，不幸的是，他们将她送到医院时，已经过了中风发作的头三小时。她现在已经和我们在一起两周了而且一直很努力地配合各位以便能回到自己的家。我们这次会议的目的是报告我们已为莉莉娅所做的事情。然后我们需要对她的出院准备作最后的决定。罗伯特，你想开始了吗？,罗伯特： 嗯，我昨天检查了她，我认为她配合治疗做得很好。我已经和莉莉娅谈过了，她似乎渴望回家。她给我留下的印象是非常独立。我询问了她的想法，回家似乎是首选。,露西： 是的，是的，她已经和我说过中风前她在家如何生活的。她女儿们也能提供支援，这一点很好。她的日常生活还需要大量帮助。辛迪，你有什么发现？ 辛迪： 我同意你们两个。她一直十分努力，坚持做给她布置的理疗运动训练，但就是我有点担心她完成基本日常活动的能力，特别是洗澡、如厕、吃饭和走动。,罗伯特：是的，我也有点担心这些个问题，嗯，可否看一下家庭评估？职业治疗师作了家庭评估吗？ 露西：还没有。我已经同职业治疗师预定了5月15日周二的家庭评估。这个评估会让我们更好地了解为了安全起见所需要制订的适应措施，让她尽可能独立。 辛迪：好的，我很高兴她有了进步。她左半身的问题已经好转。不幸的是，左侧仍有视力衰减的问题，我一直训练她侧向左边看进入视野的东西。 露西：嗯，莉莉娅将和她的女儿丽莎住在一起，直到屋子里的安全措施修整结束。 罗伯特：那很好，克丽丝，语言治疗呢？她做得怎么样？ 克丽丝：好的，我的角色一直是帮助莉莉娅练习吞咽反射，精力集中在她的吞咽问题和言语困难上。记得她刚来时，吞咽相当困难。 露西：是的，营养状况也相当差，这也有文化原因。她不习惯医院提供的食物。 克丽丝：是的，与她平常的饮食有很大不同。她的女儿们帮助解决了这一问题，她们一直带来她喜欢的食物。厨房工作人员为她将带来的食物打成浓浆。她的舌头和嘴唇功能还没恢复。想说话说清楚点相当困难。我一直在帮助她进行嘴部练习，情况当然是有所改善了。据她女儿说，她一直是一位喜欢交际的人，所以交流的能力对于她来说很重要。 罗伯特：你对她提到了出院后的语言治疗吗？ 克丽丝：没有，我还没有提到言语治疗。那是移交给社区护士的工作内容。露西，你安排转诊了吗？ 露西：还没有，我想等到团队会议后再安排。我今天下午再打电话。那么，我们可以在莉莉娅的预计出院日期上写上5月19日周六吗？,A. Read the conversation and answer the following questions.,How long has Lilia been in hospital? Two weeks 2. Who found her unconscious? Her daughter. 3. What is her main goal? To go back to her own home.,4. What day is the home assessment booked for? Tuesday, 15th May. 5. What special arrangements were made regarding her food? The kitchen staff pureed food brought in for her. 6. Where is she going to stay when she first gets out of hospital? With her daughter, Lisa 7. When is her expected date of discharge? Saturday, 19th May,B. Find out the phrases in the conversation to match the functions in a meeting.,1. Managing the meeting,2. Including/inviting other people in/into the discussion,3. Agreeing with colleagues,Lets start with The purpose of this meeting is ,Robert, do you want to kick off? Chris, what about ,I agree with both of you. Yes. Im a bit worried about that as well.,C.The Healthcare Team is made up of hospital specialists who have been involved in a patients care. Match the job titles with their job descriptions.,1. i 2. c 3. f 4. a 5. g 6. d 7. j 8. b 9. e 10. h,D.Work in pairs. Create a conversation to practice attending a team meeting for discharging Mr. Eddie Smith according to the following description.,Mr. Eddie Smith, a 56-year-old stroke victim, is going home to his wife and two teenage children. In groups of four, practise taking part in a team meeting. Student A, you are a Nurse; Student B, you are a Speech and Language Therapist; Student C, you are a Physiotherapist; Student D, you are a Doctor. open,Task 2 Referring a patient by telephone,Description,Related Information,Discussion of the nursing topic,Common patterns and questions for referring a patient by telephone,Pracitce of the task,Description,Referring a patient by telephone involves giving and receiving information. The nurse will use the information to complete a referral form at the same time as listening to information. Information is passed on about the patients current medical status and ability to perform ADLs. In addition to making telephone referrals, nurses often receive phone calls requesting information about the condition of patients in their care. Its important that client confidentiality is protected and a nurse may not give information over the phone to someone unless he/she is a physician involved in the care of the patient or if the patient has given written consent.,翻译,任务描述,通过电话转交患者包括提供和接收信息。护士要一边接听信息，一边填写移交表格。患者目前医疗状况和完成日常生活活动能力的情况通过电话传递。除了打移交电话外，护士通常还会接到咨询患者病情状况的电话。患者的隐私一定要受到保护，这一点非常重要，护士不可以将患者的信息通过电话告知任何人，除非他们是治疗患者的医生，又或患者已经写了书面同意书。,Related Information Referral information needed,The following information is needed to successfully refer a patient: patients address and phone number; patients discharge date and summary; demographic sheet with payer information; physicians homecare order; referring physicians name and phone number; patients primary care physicians name and phone number; patients history and physical; medication profile; hospital transfer summary. For the infusion referral, the following additional information is needed: current labs; signed physicians order with dose frequency and duration (a nurses verbal orders are not acceptable); PICC line should indicate tip placement and length of PICC line.,翻译,相关信息,需要移交的信息 成功转交患者需要以下信息：患者的家庭住址和电话号码；患者的出院日期和出院小结；人口统计表上付款人的信息；医生的家庭护理医嘱；转交医生的姓名和电话号码；患者初次接诊医生的姓名和电话号码；患者的病史和身体状况；用药档案；转院小结。对于输液移交，需要以下的附加信息：当前检验室检查；医生签署的剂量频率和持续时间（不接受护士的口头医嘱）的医嘱；经外周中心静脉置管输液应该说明穿刺的位置和管道的长度。,Referring elderly patients with stoke Relatives who phone for details of patient care are often unsure of hospital routines and worry they are interrupting busy staff. Re