Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

Bipolar disorder is the sixth leading cause of disability in the world among people aged 15-44. Bipolar disorder is a chronic psychiatric disorder with a significant impact on patients’ social, occupational, and general functioning well-being. Patients who are diagnosed with bipolar type 1 disorder are usually admitted to a psychiatric hospital as an involuntary patient which means that they will be cared for in a closed unit. In a critical analysis of the literature it was noted that not much is known of the experiences of patients in psychiatric wards. The researcher used a qualitative approach, with a phenomenological research strategy. An explorative, descriptive and contextual design was utilized to gain more insight into female patients’ lived experiences during their admission and stay in a tertiary level psychiatric institution. The research population was female patients who were diagnosed with bipolar disorder and who had recently experienced being admitted to and treated at a tertiary level psychiatric facility where they were treated for this condition. Purposive sampling was utilised to obtain the sample for the study. A pilot study was conducted before the study commenced to ensure the trustworthiness of the findings. The researcher obtained the data via semi-structured interviews as well as field notes and reflective journals. Data was analysed by using Tesch’s method as adopted by Creswell. Once the data had been analysed, a literature control was done in accordance with the findings. Guba’s model of trustworthiness was utilized to ensure that this study was trustworthy and credible. The researcher implemented ethical principles to ensure that no harm was done to the participants during the research study. Finally, guidelines were developed to assist professional nurses to manage patients optimally during their admission and stay in a closed unit of a tertiary psychiatric facility.

Background: A key innovation in the provision of inpatient services to facilitate the care and treatment of women with severe postnatal mental illness was the introduction of joint mother and baby psychiatric hospitalisations, where both the mother and baby are admitted to hospital together. This study examined the history of the practice of joint mother and baby admissions across the UK and critically explored the processes relevant to the diffusion of joint admissions and patterns of service development to identify the possible and probable causes for significant differences in service provision across the United Kingdom (UK). Aims: The study examined the documented history of the development of practice of joint mother and baby psychiatric hospital admissions across the UK and in doing so, a) Identified the pattern of service and practice development and the likely reasons for the pattern of the chronology. b) Identified the processes involved in the diffusion of joint mother and baby admissions in the UK, and explored why the practice was sustained (or not). c) Contributed new information to the continued development of innovation diffusion theory and research, and its application to health care service and practice development. Methods: A historical method was used in the study and was reported through the use of historical narrative and analysis. Data was collated from primary and secondary sources of documented evidence which was used to inform the history of joint mother and baby admissions across the UK. Data was analysed using the theoretical framework of diffusion of innovation (Rogers, 2003). Findings: Two versions of the same innovation were identified: joint admissions to side rooms of general adult psychiatric wards or annexed areas of the wards and joint admissions to specialist mother and baby units. Neither version of the practice followed the normal S-curve pattern of adoption in terms of frequency and rate of adoption. After a period of approximately 63 years there are 24 facilities for the provision of joint admissions in the NHS in the UK. The main influencers to the adoption of the practice was perception of risk, social networks internal and external to the NHS, the presence of clinical and political champions to drive the adoption and implementation of the innovation and policy entrepreneurship by clinicians working in the clinical field of perinatal mental health. The development of specific policy, guidelines and in Scotland, legislation, has resulted in a move during the last decade from joint admissions being diffused naturally to side room admissions being actively withdrawn and specialist psychiatric mother and baby units actively being disseminated. There is strong evidence that the diffusion process for specialist mother and baby units is still in motion at the time of reporting. Conclusion: Two competing versions of the same innovation had unusual patterns of diffusion. The influencers identified as relevant to the diffusion patterns of each version of the innovation were essentially the same influencers but they were used in different ways to affect change: rejection of one version of the innovation in favour of adoption of the other. The main influencers on the diffusion of joint admissions changed over the time line of the adoption pattern. Barriers to diffusion included the absence of evidence of effectiveness, the absence of economic evaluation, the position in service divisions of perinatal mental health as a field of practice and the absence of succession planning across professional groups. Recommendations are made for future research.

The mentally ill who have been found not guilty of a crime by reason of insanity (NGRI), appear to be at risk in several areas when confronted with the judicial system. The purpose of this study is to determine whether the factors which predict recidivism of NGRI patients in Community Out-patient Treatment (COT) also inhibit a patient's release into a conditional release program (CONREP).

This project offers evidence and data to measure how progressive and sustained mobilization strategies that are implemented by nurses impact early discharge on a single stay Cardiothoracic Intensive Care Unit for patients undergoing first-time Coronary Artery Bypass Surgery (CABG) surgery.

In recognition of the inherently inflationary nature of retrospective reimbursement, the Reagan Administration enacted legislation that substantially changed Medicare's hospital reimbursement system. The Prospective Payment System (PPS) mandated paying hospitals a fixed payment, set in advance, based on the patient's diagnosis rather than retrospectively paying for all services delivered to a patient. Critics contend that PPS introduces incentives for hospitals to conserve resources during the hospital stay and to shift care to less costly settings, both potentially affecting quality of care to the elderly. The question addressed by this dissertation is whether there were changes in the discharge health status and post-hospital placement of Medicare beneficiaries as a result of the implementation of PPS. Using a quasi-experimental time-series PRE/POST design, data was collected from the medical records of 2,619 Medicare beneficiaries (1,258 in the PRE-PPS period; 1,361 in the POST-PPS period) hospitalized between 1981 and 1986. Two large (300+ beds) and two medium-sized (100-300 beds) hospitals, representative of hospitals in the Portland metropolitan area, served as data collection sites. Medical records were selected from five Diagnosis Related Groups (DRGs): three medical DRGs (stroke, heart failure, and pneumonia) and two surgical DRGs (hip replacement and major joint pinning). Analysis of the data show that overall length of stay declined from 11.3 days in the PRE-PPS period to 8.6 days in the POST-PPS period, a reduction of 2.7 days and significant at the p = $<$.001 level and a significant increase in Dependency between the PRE and POST periods for four of the five DRGs studies (Stroke, Pneumonia, Heart Failure, and Hip Replacement). Finally, an analysis of differences in post-hospital placements shows a significant increase in POST-PPS placements to home alone (p = $<$.05), home health (p =.01), and for hospital transfers (p = $<$.001). Though limited in its generalizability, the data presented in this dissertation support the contention that Medicare patients are leaving the hospital sooner, in more dependent states of health than before PPS, and that greater numbers of potentially high care patients are being discharged to home and to home health.

Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.

MCur / Department of Advanced Nursing Science

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital. / AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

MCur / Department of Advanced Nursing Science / Background: In South Africa the Mental Health Care Act No. 17 of 2002 direct district hospitals to render 72-hour assessment of the MHCU’s. In Vhembe district 72- hour assessment is implemented in public general hospital. Purpose: The study determined the experiences of family members regarding 72-hour assessment admission of MHCU’s at selected hospital in Vhembe District. Methodology: The research design was qualitative, exploratory, descriptive and contextual in nature. The study population consisted of the family members of the MHCU’s admitted for 72-hour assessment. Purposive sampling was used to select 10 family members. This study used in-depth individual interviews to collect data until data saturation was reached and analysed using Tesch’s steps. Ethical consideration and measures to ensure trustworthiness were given attention to throughout the study. Results: Three themes emerged from analysed data which is negative experiences of family’s members, family member’s experience on coping mechanism and structural constraints. Recommendations: This study recommends further research study on the development of a model to support the family members in their caregiving role The study recommends further research study on the experiences of the health care professional regarding 72-hour assessment of a MHCU’s / NRF