HOSPITAL

ADMISSION AND DISCHARGE

Admission :
• Admission refers to an entry of patient into the
health care facility for therapeutic or
diagnostic purpose, that may be hospital or
any other health care facility that provides
health care.
• Admission into a hospital is an extremely stressful
situation for patient and their families. The patient
often experience pain or other symptoms like
discomfort or aches.

• The surrounding of the hospital such as new sights

sounds and smells that may interfere with patient's
comfort.
• Each person's reaction to the hospitalization is
unique, however there are some common reactions
which the nurse can expect are; fear of the unknown,
loss of identity, disorientation, separation anxiety
and loneliness.

• The fear of unknown cause, insecurity, the anxiety

and loneliness reflects a need for belongingness and
love.
• The nurse must help to reduce the severity of
these common reactions to hospitalization
with a warm and caring attitude with courtesy
and empathy.
• Treating each patient with respect, maintaining

dignity, involving him in plan of care and adjusting

hospital routine to meet their desires will help the

patient adaptation to hospital surrounding.

Purposes of admission
• To provide immediate care.

• To provide safety and comfort to the patient.

• To manage and improve the general condition of

patient.

• To orient patient to hospital environment and

available services.

• To diagnose the condition by observing signs and

symptoms of a disease condition.
Purposes of admission
• To be ready for any emergency.

• To facilitate follow up of the patient.

• To undertake laboratory and radiological

procedures.

• To obtain information about patient such as any

information that serves as a basis of care e.g.
Allergy, Diabetes etc.

• To establish interpersonal relationship

• ROUTINE/ELECTIVE ADMISSION
Clients are admitted for investigations and
planned treatment and surgeries.
E.g. patient with diabetes, hypertension,
jaundice etc
ARTICLES FOR ADMITTING PATIENT

• Complete set of admission form.

• TPR sheet, medicine chart, I/O chart, nurses record,

progress record chart, additional chart.

• Physical examination tray: vital signs tray,

measuring tape, torch light, hammer, scale, weight
machine, height chart, tuning fork, tongue spatula.
ARTICLES FOR ADMITTING PATIENT

• Bath tray including hospital dress.

• Specimen container

• Prepared bed

• Bedpan

• Urinal
Tongue Depressor
Urinal
Admission procedure

• Wash hands and prepare all required equipments. Prepare

the bed.

• Assemble special equipments such as suction machine,

oxygen supplies, IV stand etc. as per need and make sure
that they are in working condition.

• Greet the patient and his relatives in a pleasant manner

and introduce yourself, staff members and other patients
and visitors.
• Receive the patient along with the admission form to
assigned bed.

• Keep the patient comfortably and assist him/her

accordingly.

• Observe the general condition of the patient from

head to toe, if any abnormality found inform the
concern doctors and manage immediate care.
• Check vital signs including height and weight of the
patient and report if any abnormality found and
carry out the immediate orders.

• Register patient's name in the admission book,

census form, plan card and in any other register as
per the rule of the hospital.
• Get consent form signed by the patient and the visitor
after explaining the purpose.

• Orient patient to the physical set up of ward such as

treatment room, nurse's station, toilet, bathroom, water
supply and kitchen, patient's cupboard, daily routine of
ward including meal time, medication time, wake up
time and doctors round time and the hospital policies
regarding visiting hours, gate pass and restrictions in
ward.
• Help patient to change clothing and maintain hygiene
such as nail care, hair care etc.

• Obtain detailed nursing history and perform physical

examination.

• Complete the admission chart with complete

admission report in the patient's chart including date,
time of arrival, patient's general condition, vital signs
and any abnormalities and interventions and notify
physician of patient's arrival.
• Obtain specimen such as urine, blood, and stool
sputum as needed.

• Ask relatives to bring daily use equipments e.g. towel,

comb, soap, oil, toothpaste, toothbrush etc. Handover
valuable things to the family.

• Isolate the patient if the patient is suffering from

communicable diseases and inform this to the patient
party.
• Avoid physical and psychological trauma to the
patient.

• Observe policies in dealing with medico-legal cases.

• Provide psychological support to the patient.

 PHASES OF NURSE CLIENT
RELATIONSHIP
• Orientation phase

• Working/ exploration/ identification phase

• Termination phase
Phases of a therapeutic nurse-client
relationship

1. Preinteraction phase

• Begins before the nurse's first contact with the

client

• Develops appropriate physical and interpersonal

environment (seating, lighting) to promote comfort
and facilitate collaboration

• Anticipates potential client issues.

• Prepares for the client interaction.

• Determines how to initially approach client

• The nurse should identify personal preconceived

ideas, stereotypes, biases, and values that may
impinge on the nurse-client relationship
2. Orientation or introductory phase

• Acceptance, rapport, trust, and boundaries are

established.

• Introduces self to the client by using first and last

name and designation

• Identifies purpose and the time frame of the

relationship (establishing a contract)
2. Orientation or introductory phase

• Identifies client's strengths and needs.

• Collects data and forms basis for diagnosis and

client-centered goals

• Termination and separation of the relationship are

discussed in anticipation of the time limited nature
of the relationship.
3. Working phase
• Exploring, focusing on, and evaluating the client's
concerns and problems occur; an attitude of
acceptance and active listening assists the client to
express thoughts and feelings.

• Actively problem solves with the client

• Uses interpersonal strategies to help the client

identify effective coping strategies

• Encourages self-direction and self-management

whenever possible to promote health and wellness
4. Termination or separation phase

• Prepares the client for termination and separation on

initial contact

• Evaluates progress and achievement of goals

• Identifies responses related to termination and

separation, such as anger, distancing from the
relationship, a return of symptoms, and dependency
4. Termination or separation phase

• Encourages the client to express feelings

about termination.
• Identifies the client's strengths and
anticipated needs for follow-up care.
• Refers the client to community resources and
other support systems
Discharge Procedure
• Discharging the patient refers to releasing a patient
from hospital or health care facility to home. It is a
process of preparing the patient for departure from
the hospital with approval of the doctor.
• Discharge planning prepares a client to move from
one level of care to another within or outside the
current health care facility and aims to improve the
co-ordination of services after discharge from
hospital by considering the patient's needs in the
community.
• Only a doctor can authorize patient's release from
hospital, but the process of discharge is completed by
nurses.

• Discharge planning includes the physical condition

of the patient before and after hospitalization, details
of care needed, information regarding patient's
condition, information on medications and diet, extra
equipments needed, such as a wheelchair, commode
or oxygen etc.
• Discharge planning is an inconsistent process which
varies from hospital to hospital

• Some basic questions patient may ask are:

• What precautions are to be taken during:

Bathing, maintain personal hygiene, dressing,
grooming, mobility and special devices in certain
conditions.
Eating (diet restrictions, e.g. soft foods only, certain
foods not allowed)Managing symptoms (e.g. pain or
nausea), what to do in emergency?
• Questions about medications:
Why is this medicine prescribed? How does it work?
How long the medicines have to be taken ?
Should this medicine be chewed, crushed, dissolved?

What possible problems might I experience with the

medicine?
Should this medicine be taken with food? Are there
any foods to avoid
• Questions about follow-up care:
When to come back for follow up care, the day and
time of visit.
The concerning doctor to meet, the process for
follow up visit.
Purposes of discharge planning

• To answer all quarries that the patients and the

patients family have.

• To assist patient in making the change from hospital

to the home environment.
Purposes of discharge planning

• To ensure the continuity of care to the patient after

discharge.

• To make the patient comfortable in a healthy

environment.

• To co-ordinate referrals to appropriate hospital or

rehabilitation centre.
• Discharge on Request- In this type of discharge,
treatment is not complete, but by taking the patient
out of hospital, there is no immediate danger to the
life of the patient
Articles required: Patient's all records, discharge
paper and register, wheel chair or stretcher

Discharge procedure

• Check written order for discharge and inform patient

and their relatives in time.

• Prepare and check the patient's entire documents and

the discharge ticket along with the discharge register.

• Get clearance from various units as needed for e.g.

pharmacy, dietary, laboratory etc.
• Send the patient's chart, discharge ticket to billing
counter with relevant informations.

• After clearance of the bill, give instructions regarding

diet, sleep, rest, exercise, medications including dose,
time, duration and complication of diseases, home
care, follow up visit and care of wound in case of
surgical case.
• Collect equipments that the patient has used and
handover patient's belonging.

• Assist the patient in dressing, packing, instruct

relatives to assist him/her.

• Obtain wheel chair for patient who is unable to

ambulate and say goodbye to the patients.
• Complete documentation of discharge in nurse's
note, write the date of discharge in admission book
and maintain the census.

• After patient has gone, disinfect the bed and prepare

for next use.
• Points to remember
If patient leaves the hospital against medical advice
the procedure is same as the discharge process except
a discharge ticket is not given to the patient.
 In such case the patient or the relative is asked to
sign the statement that he or she is taking the patient
on their own will and responsibility.
 This is a sort of legal protection of the hospital
authorities who can be sued in court if the patient
acquired any life threatening conditions after leaving
the hospital.
In case of police case like suicide, physical assult,
RTA the on duty nurse should inform the on duty
police before the patient leaves the hospital.
When patient escapes form the hospital without
informing the on duty staff and hospital
administration and without having the financial
clearance then the case is considered as absconded
and need to be informed to the seniors, security and
hospital administration.
If the patient is transferred to another hospital for
further treatment the relatives and patient should be
provided with a transfer certificate.