-2 on next visiting Colonial Hills would know of Mr. Brown's admission and would follow through by conferring about him with the charge nurse.* This would provide the addition to Mr. Brown's patient care plan of elements of care recognized by specific human care disciplines. Mr. Brown began to enjoy the craft program, the daytime companionship of his peers, and the regularity of the nursing care and the assistance routines. He also liked the regular hours for meals in the Home. His daughter visited frequently and on occasion was his guest for a weekend lunch. On the thirteenth day after admission to Colonial Hills, with specific written permission from his physician, Mr. Brown was taken out for an automobile ride by his daughter. A car accident occurred almost at the door of Barton Army Hospital; so both father and daughter were admitted there on an emergency basis. A phone call came into Colonial Hills Nursing Home the next morning after the accident saying that Mr. Brown was very upset emotionally, crying constantly, and pleading to be sent "home" in spite of his bruises and weakness. He had suffered a broken right wrist (now in a cast). His daughter was in agreement that he be sent back to Colonial Hills although she herself was being transferred to Dixon Medical Center for further evaluation and treatment. The Director of Nursing Services gave the social service department at Barton Hospital the name and phone number of Mr. Brown's regular physician in order for the military physician to confer with him and so that the two physicians might evaluate the situation and initiate the transfer procedure if indicated. The two physicians concurred that although Mr. Brown was temporarily very ill, that he could be best cared for and enjoy more emotional support if returned to the skilled nursing home where he was known and felt "at home." *At the admitting desk, where patient information cards (4 x 6) are filed alphabetically, the card corner is tabbed with a red flag on admission day. On the eighth day of stay the tab is changed to an amber colored one; and on the twenty-first day a green tab takes its place on the card, Each professional consultant checks this file when visiting; he notes those new patients whom he has not seen. Then he confers with the nurse in charge of the shift to ask if he needs to see in each case - the patient's chart, the patient himself for complete evaluation where the orders involve his specialty, or to act in any way in reference to each patient on his list. -3 Mr. Brown when readmitted to Colonial Hills now presented a completely altered set of difficulties in nursing care. He appeared to be psychologically off balance and displayed a number of emotional symptoms. He was bruised and sore all over; but his knee was extremely tender. He could not use a cane in either hand. In the afternoon shift-change conference on the day of his readmission, the staff assessed the altered conditions and determined that the patient was to have added help with activities of daily living (such as feeding, bathing, dressing, etc.), that his emotional upset could be recognized as temporary and he could be supported during this time by having someone from the staff call for a report on his daughter's progress each day, by seeing that each staff member assumed his early recovery and return to ambulation, by having all the staff extend special friendly gestures, and by an immediate start on some recovery oriented specifics which the patient would participate in such as: quadriceps muscle setting exercises, gluteal pinching exercises, and ankle and shoulder range of motion. Mr. Brown's progress toward recovery was slow and uneven, characterized by petulance and frustration at intervals since he worried about his daughter's condition as well as his own helplessness. The care plan for this patient went through so many revisions that the form sheets were twice worn out and had to be replaced; however, the advantage of a constantly flexible and progressive attitude toward care specifics and the richness of scope brought to this care by the contributions of the related care personnel shaped a happy ending of improvement and a return to his home sixty days after his readmission date. The final copy of Mr. Brown's care plan went with the inter-agency referral form by way of Mr. Brown's physician to the Director of the Medical Center's home care team who could visit Mr. Brown at least once in his home setting after discharge from Colonial Hills Nursing Home. References Allgire, Mildred and Denny, Ruth. Nurses Can Give and Teach Rehabilitation. Springer Publishing Company, New York, 1960. ANA Statements of Functions, Standards, and Qualifications. Reprinted from American Journal of Nursing, Vol. 56, September, 1956, 4 p. Bachmann, Gladys D. Hospitalwide Education Program Updates Skills in all Conditions of Participation for Extended Care Facilities, DHEW, HIM-3, Elementary Rehabilitation Nursing Care. Public Health Nursing Section of the Colorado State Department of Public Health. PHS Publication No. 1436. 100 p. 1966. Ho, Elsie. Make Each Person Count. U. S. Government Printing Office, Hunnisett, F. W. Continuing Training for All. Canadian Hospital. 41:7, Lehman, Katherine B. Incorporating Rehabilitation into Extended Care. Miller, Mary Annice. Essentials for Self and Staff Development, American Miller, Mary Annice. Sources for Assistance in Inservice Education. National League for Nursing, New York, 1962. 18 p. Miller, Michael B. et al. Nursing in a Skilled Nursing Home. American McQuillan, Florence L. Nursing Homes Must Grow Their Own Employees Through In-Service Education. Modern Nursing Home Administrator. 1966, p. 119-122. Nursing Care Plans, Hospital Research and Educational Trust. Quest for Quality: A Self Evaluation Guide to Patient Care. for Nursing, New York, 1966, 77 p. 20.5, October, Hospital Education National League Standards for Organized Nursing Services in Hospitals, Public Health Agencies, Nursing Homes, Industries, and Clinics. American Nurses Asssociation, New York, 1965, 16 p. Statement on Nursing Staff Requirements for In-patient Health Care Services. Committee on Nursing Services, American Nurses' Association. American Journal of Nursing. 67.5, May, 1967. 1029-1030. II. III. Possible Solutions to Problems and Discussion Patterns of Administration for Long-Term Care Administrative Alternatives for Long-Term Care Colonial Hills Organization Chart Statement of Organization of the Patient Care Policy Committee Addendum to State of Organization: Medical Staff Rules and Requirements for Patient Care Policies References IV. Instructor's Guide: Patient Care Policies CASE STUDY ADMINISTRATION OF PATIENT CARE PROGRAMS THE POLICY COMMITTEE AND PATIENT CARE POLICIES The Broblem: Colonial Hills, a modern 100-bed proprietary medical and nursing care facility near Dixon and Fernville in Tiller County, Anystate, U.S.A., must set up a policy committee and written patient care policies and procedures in order to participate in the health care programs established by the Social Security Amendments (Medicare and Medicaid), and to qualify for accreditation under the standards established by the Joint Commission on Accreditation of Hospitals. Background: This extended care facility was built by a group of physicians and community leaders in anticipation of the need for more beds in the community with the advent of Medicare and Medicaid. The members of the owner-group comprise the board of directors. The administrator, William F. Jones, is accountable to them. Mrs. Mary F. Hills, R.N., is director of nursing services. There are no plans for an organized medical staff at present, but Dr. William Buckley, a member of the board, has been acting as advisory physician. Dr. Harold Prince, director of the Fernville Hospital, Dr. Samuel F. Garvin, a dentist, and Dr. Ralph Harder, a general practitioner and president of the Tiller County Medical Society, are the members of the board most familiar with the facility, as they acted as an operating committee through the construction and early operation of Colonial Hills, before the present administrator was hired. Most of the other health personnel are on a part-time or consulting basis at present. Faced with the need for a policy committee to draw up a statement of the policies and procedures which will govern those providing the nursing care and related medical services of the facility, Bill Jones has asked Dr. William Buckley to head such a committee. Dr. Buckley has agreed to do this on a "one-shot" basis, but then suggests that someone else head the committee on a continuing basis. Questions to consider: 1. Whom should Dr. Buckley ask to be on the committee to draw up a basic statement of patient care policies? What are the topics that should be covered in such a policy statement? 2. 3. What is the difference between patient care policies and procedures, and where does the responsibility for each lie? If Dr. Buckley and his committee produce a statement of patient care |