The Role of Ambulatory Setting Nursing Staff in Discharge Planning: An Application of Driscoll's Reflection Model
Nurses at all levels and in all areas of practice have been increasingly involved in developing, recommending, an carrying out patient care over the course of the twentieth and twenty-first centuries, and the rate at which knowledge and acknowledgement in the field is growing has itself picked up the pace tremendously. This can be seen in nursing research and in simple day-to-day nursing activities in standard nursing wards and situations; nurses are now often the primary care providers for patients in a variety of situations, which entails a great deal more decision-making authority and capability than was expected or granted early in the twentieth century and in decades prior. Unquestionably, nurses have now become a well-respected and well-integrated part of medical practice.
At the same time, the roles that nurses can and should take on in various situations are not always incredibly well defined. Physicians and administrators, not to mention nurses themselves, can be unsure of what level of independence and decision-making authority it is proper to expect nurses to rise to in specific situations, and patient feelings on the subject must also be considered. Furthermore, different individuals involved in any area of medical practice can have widely differing opinions on these maters, making it difficult for nurses to adjust to and solidify their roles in various departments and institutions. This paper will attempt to address this issue in one particular area of medial and nursing practice.
Specifically, the role of nurses working in ambulatory in-patient care settings in the developing, planning, and implementation of discharge recommendations and procedures will be examined and more concretely ascertained in the following pages. Driscoll's model of nursing reflection will be used as the framework for this investigation, helping to define the parameters of the nurse's role and the investigations that might assist in further defining and making more concrete the specific decision-making capabilities with which nurses are and should be endowed in current care settings and practice. A review of existing literature on the subject will provide the real data for use in conjunction with Driscoll's reflection framework in order to provide a truly evidence-rooted and current analysis of the research question. Through these methods, an applicable model for the role of nurses in regards to ambulatory care patient discharge recommendations and procedures can be made.
The Driscoll Reflection Model
There are a variety of different tools that can be utilized to aid in an investigation of nurses' role in various settings and car situations. One such tool is Dircoll's Model of Reflection, which actually has much broader application potentials and can be used as a means for assessing the actions and outcomes of practically any situation (Quinn 2000). This model is very simple and direct, yet can have profound results in regards to learning from experience and helping to develop and understand future attitudes and roles that would be appropriate in a variety of situations (Davis 2010). By asking three basic questions, this model extracts a great deal of knowledge from experience.
The first question in the Driscoll Model of Reflection is simply, "what?" (Davis 2010; Quinn 2000). This can be seen as the initial descriptive phase of the reflection model, where the actual circumstances and observations are listed (Davis 2010). More specific guiding questions that can be answered in this phase include simple things like, what was going on? What did you see? What actions were taken by you and others? What occurred as the situation progressed? (Quinn 2000). This is also the phase where they key elements of a given situation should be identified, and being able to recall the salient details of the situation in a timely and effective manner is quite beneficial for ongoing success in the later phases of the model (Davis 2010). Developing an understanding of the purpose for undertaking the reflection is also important at this stage (Quinn 2000).
The second question in this model is, "so what?" (Davis 2010; Quinn 2000). Just as the first question was descriptive of the situation, this question is descriptive of the context -- feelings both at the time of the situation and at the time of reflection (i.e. "now"), the effects of actions that were taken, noted troubles that emerged from the situation, experiences that differed from those of colleagues, and other similar considerations should be examined in this phase (Quinn 2000). This phase relies heavily on analytical and evaluative abilities, rather than being purely descriptive as the first phase is (Davis 2010). Essentially, this defines the importance of the situation being reflected upon, both in terms of degree and in terms of direction, as well -- the "why" of the issue's importance (Davis 2010).
Finally, the question "now what?" allows for the development of action from the previous questions asked in Driscoll's Model of Reflection (Davis 2010; Quinn 2000). Contemplating differences in practice or the actions taken in specific situations in the future that would improve the outcome and lead to more positive physical and emotional effects can lead to real changes in practice and recommendations, altering the function of nursing slightly so as to improve outcomes for all stakeholders (Davis 2010). Specific questions that are asked during this phase of reflection under Driscoll's model include, what are the implications on personal practice and attitude? What needs to happen to alter the situation? What can be done/are you going to do about the situation? What information might be useful in a similar situation in the future? How can such information be obtained? (Quinn 2000). By answering as many as possible of these and related questions that are applicable to any given situation, more concrete and experience-based practices for nursing in similar situations can be developed, for both individual nurses and the nursing community as a while.
The Role of Nurses in Ambulatory Discharge Proceedings
From the description of Driscoll's Model of Reflection given above, it might seem s though this framework were best suited to individual situations rather than larger questions of nursing practice. The framework remains applicable regardless of scale, however, and some adjustment in the specific questions asked makes this tool incredibly useful for helping to develop nursing policy. This includes developing an understanding of the role of nurses in discharge decision-making.
The answer to the question of "what?" In this situation must be framed in a manner that describes the situations and salient details that require nursing involvement in discharge decision making. Specific aspects of discharge decisions that have previously been identified as key areas for nursing concern include any deviation from known procedures, general health assessments and potential outcomes for patients (especially signs that a discharge might be premature), and assurance that the entirety of the patient's treatment record at the ambulatory care setting is known to the physician making the ultimate discharge decision (Burden et al. 2000; Lundy & Janes 2009). Patient education and knowledge of post-discharge self-care practices and follow-up needs have also been deemed a major part of nursing responsibility when it comes to discharge proceedings (Lundy & Janes 2009).
The "so what?" question comes next in Driscoll's model, and in this situation the context is largely a matter of patient outcome, as identified by the key aspects of discharge proceedings and procedures identified in the literature (Burden et al. 2000; Lundy & Janes 2009). Attitudes following discharge should include confidence and positive feelings regarding the health and progression of the patient, and feelings of misgiving at any point during or following the discharge should be attended to and followed through with additional investigation, research, and potentially physician and/or patient contact (Lundy & Janes 2009). Specific problems that have been noted with a lack of adequate nursing involvement include insufficient prescription preparation,…