Admission, transfer, referral, and discharge of the patient

Admission: is entering a health care agency for nursing care and medical or
surgical treatment.
Types of admission:
1. Inpatient: length of stay more than 24 hours. Eg. Acute pneumonia, major
surgery, major trauma, unrelieved chest pain.
2. Outpatient: length of stay less than 24 hours. Eg. Physical therapy, minor
surgery, cancer therapy.

Purposes of admission
1. To help a new patient to adjust to hospital environment and routines.
2. To alleviate the patient's fear and worry about the hospitalization.
3. To facilitate recovery of patient from his/her problems

Process of patient admission to hospital

1. Check for orders of admission.
2. Assess the patient's immediate physical and emotional needs and take action to
meet them.
3. Make introduction and orient the patient
4. Introduce self to the patient and the family
5. Orient patient to individual unit.
6. Orient patient to the entire unit.
7. Explain anything you expect a patient to do in detail. (This helps the patients
participate in their care).
8. Introduce other staff and roommates.

General assessment

Observation and physical examination such as:

1. Vital signs; temperature pulse, respiration and blood pressure.

2. Intake and output

3. Measure the weight of the patient
4. Height is measured (if required)
5. Interview patient and take nursing history to determine the patient conditions.
6. Take care of the patient's personal property

Transfer of the patient to another unit

Transfer of the patient to another unit is done for several reasons. Explain the transfer
to the client and the family. Help the patient to assemble all the belongings, charts,
x-films and lab reports, and medications. Record the transfer in a transfer note. Give
the time, the unit to which the transfer occurs, types of transportation (wheelchair,
stretcher), and the physical and psychological condition. Make sure that the
receiving unit is ready.

Discharging a Patient

1. Check for orders that a patient need to be discharged

2. Plan for continuing care of the patient
3. Teach the patient about what to expect about disease outcome, medications
(Treatments), activity, and diet.
4. Do final assessment of physical and emotional status of the patient and the ability
to continue own care.
5. Keep records.
6. Write discharge note.

Discharge summaries:

1. Description of client’s condition at discharge

2. Treatment (e.g. Wound care, Current medication)
3. Diet
4. Activity level
5. Restrictions
Referral

Referral is a condition in which a client/patient is sent to a higher health care system

for better diagnostic and therapeutic actions.

Give the following information to the next health facility:

 Any active health problems

 Current medication
 Current treatments that are to be continued
 Eating and sleeping habits
 Self-care abilities
 Support networks
 Life-style patterns
 Religious preferences

Basic daily care of the patient

1. Care of the patient unit
2. Feeding
3. Medication
4. Measurement of the Vital Signs

The adult patient care unit

The patient care unit is the area of the hospital in which the patient receives
medical and nursing care and treatment as well as the place in which he/she lives
during hospital stay.
Types of patient unit:
1. Private room – is a room in which only one patient be admitted
2. Semi private room – is a patient unit which can accommodate two patients
3. Ward- is a room, which can receive three or more patients. Consists of a
hospital bed, bed side stand, over bed table, chair, overhead light, suction and
oxygen, electrical outlets, sphygmomanometer, a nurse’s call light, waste
container and bed side table and others as needed and available.
4. In the home, the client unit is the primary area where the client receives care. It
may be bedroom, or the main living area.

Hospital Bed
Gatch bed: a manual bed which requires the use of hand racks or foot pedals to
manipulate the bed into desired positions i.e. to elevate the head or the foot of the
bed.
Handles should be positioned under the bed when not in use.

Side rails
It should be attached to both sides of the bed.
Full rails – run the length of the bed
Half rails – run only half the length of the bed and commonly attached to the
pediatrics bed.

Bed Side Table/Cabinet

 Is a small cabinet that generally consists of a drawer and a cupboard area with
shelves.
 Used to store the utensils needed for clients’ care. Includes the washbasin (bath
basin, emesis (kidney) basin, bed pan and urinal.
 Has a towel rack on either sides or along the back.
 Is best for storing personal items that are desired nearby or that will be used
frequently.
E.g. soap, shampoo, lotion etc.

Over Bed Table

Can be positioned and consists of a rectangular, flat surface supported by a side bar
attached to a wide base on wheels alongside or over the bed or over a chair. Used
for holding the tray during meals, or care items when completing personal hygiene.

The Chair
Most basic care units have at least one chair located near the bedside for the use of
the client, a visitor, or a care provider.

Overhead Light (examination light)

It is usually placed at the head of the bed attached to either the wall or the ceiling. A
movable lamp may also be used. Useful for the client for reading or doing close
work. It is important for assessment.

Suction and Oxygen Outlets

Suction is a vacuum created in a tube that is used to pull (evacuate) fluids from the
body E.g. to clear respiratory mucus or fluids.

Characteristics of the patient care unit

1. Safe
2. Pleasant
3. Clean
4. Orderly environment for the patient's physical and mental wellbeing.

Principles of Patient Hygiene

Providing for a patient's hygiene is the most important thing not only for the patient's
physical needs, it also contributes immeasurably to the patient's feeling of emotional
well-being.