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The Evaluation and Development of the Prototype Model of Discharge Planning

Which is being Organized and Based on Information Technology

Rr. Tutik Sri Hariyati, Efi Afifah, Hanny Handayani

ABSTRACT

Discharge planning need to be done. The aim of discharge planning is to prepare the

patient and the family to return home. The purposes of this study are to identify the

implementation of discharge planning, to develop an organized discharge planning

model, and to evaluate the implementation of this DP model. The results of this study

indicated that the nurses’ knowledge increased significantly after the model of

discharge planning which is being organized was introduced (mean before

intervention = 11.16, after = 16.81, p value = 0.000). While the impact to the

implementation of discharge planning showed that there is a significant increased in

implementing discharge planning (mean before intervention = 50.3, after = 59.33, p

value = 0.000). The interview with head of ward and the nurses showed that: they got

the advantages from learning media bases on Information Technology (CD) in

helping the discharge planning. Learning media also helped patient and family.

Key word: Discharge planning, nursing, return home, Information Technology,

learning media,

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I. INTRODUCTION

Everybody is longing to live a healthy, active, and productive life; however, when

they’re in unhealthy condition they will search for help from health services. One

kind of health services is hospital. Hospital is one of health services which gave

health service from multidisciplinary. A good collaboration between

multidisciplinary such as doctors, nurses, nutrition specialists, physiotherapists,

pharmacists, and others is expected to be able to give a good health service to the

community.

Nurse is one kind of caregiver who had a big contribution in increasing the quality of

health service. Nurse is considered as the sharp point of health services in hospital

since nurse has the longest interaction time with patients and families. Nurse acts as

host in hospital ward and assists patients and families within 24 hours a day.

Perry & Potter (2001) defined that nurse role as caregiver include as collaborator,

educator, counselor, change agent, and researcher. Nursing has characteristics of

profession, including having body of knowledge which is different from other

profession: altruistic; having profession organization; having profession standard and

ethics, accountability, autonomy, and partnership (Leddy & Pepper, 1993 in

Nurachmah, 2004).

Nowadays, there still reports about nursing service which is still not optimal. One of

the nursing activities which is still not optimal is discharge planning. Discharge

planning is a part of nursing process and also the main function of nursing care.

Discharge planning is a systematic planning process which being prepared for patient

who planned to leave the nursing care institution (hospital) and to maintain the

continuity of nursing care. Patient who didn’t get discharge planning, especially

those who need home care, health counseling or elucidation and community service

will be back to emergency room within 24 – 48 hours later and then went home again

(Swanburg, 1999). The relapse condition will, of course, give disadvantages to

patients, families, and also the hospital. The hospital which is often experience this

condition, will be left by the costumers, sooner or later.

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Research in hospital ward in two different hospitals in Jakarta showed that in X

Hospital, 36% of nurses haven’t done discharge planning (Fahruji et. al., 2006), and

in Y Hospital, 20% of nurses haven’t done discharge planning (Ramie et.al., 2006).

In Y Hospital 56% of discharge planning haven’t have a standard structure and

haven’t based on the need of patient.

Ramie (2006) also stated that 84% of nurses haven’t had Course document (Satuan

Acara Pembelajaran/ SAP) in doing the discharge planning and 24% of nurses stated

that the learning media provided by hospital didn’t passable for doing discharge

planning, thus caused problem in doing a good discharge planning.

In other research about the used of discharge planning, showed an increased in

readiness to leave the hospital from stroke patients who gave discharge planning

according to program. Discharge planning gave an increasing effect in readiness and

coping to stress, from 78.9% to 88.9% (Hariyati, 2002).

Considering how important the implementation of a structured discharge planning is,

the researchers interested to assess more, especially for those problems that related

with discharge planning, and the determinant factors which affect the successfulness

of discharge planning. After doing the identification process, researchers develop a

model of discharge planning which is being organized and based on information

technology.

Being organized meant there will be a standard prototype model in discharge

planning, started from the patient first come to hospital up to the patient is going to

return home, have a slot system, have a Course document, have an exact and accurate

documentation and evaluation system. Beside that, the information technology model

also being developed due to the development of science and technology, and the

ability of information technology system to simplify the patient’s learning process,

not only by leaflet and poster, but also by the interactive multimedia media.

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Purpose

To identify the implementation of discharge planning in hospital ward, and to

develop prototype model of discharge planning which is being organized and based

on information technology media.

Specific goals

1. To identify the implementation of discharge planning

2. To identify factors that affect the implementation of discharge planning

3. To develop the prototype model of discharge planning, slot system, Course

document, computerize discharge planning documentation system, and

learning media based on interactive media such as CD/ compact disc.

The Use of Study

1. For caregiver

To evaluate the implementation of discharge planning and problems that

being faced in discharge planning, beside that it can help to develop an

efficient discharge planning model, can be implemented. This model will be a

basic in developing the prototype of discharge planning in hospital.

2. For patient and family

To help the preparation and continuity care at home, and to prevent the risk of

relapse.

3. For educational institution

To become basic for further research about the correlation between this

model and the client’s satisfaction level, correlation between this model and

the prevention of relapse level. Beside that, this model has potential to get

intellectual property right, thus it can be used in other hospitals.

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II. METHOD

A. Design

This study used triangulation study approach. In the problems identification phase,

the researcher used descriptive explorative design and descriptive correlation with

cross-sectional approach, in which researcher identified the implementation of

discharge planning, factors that affect the implementation of discharge planning.

In the second phase, the researchers together with hospital wards developed the

prototype model of discharge planning which is being organized and based on

information technology system. In this phase, the slot system, computerized

discharge planning documentation, Course document, and interactive media/CD

based on current illness cases where for model purpose will be developed 4 learning

CD.

In the third phase the experiment of prototype model is being held in 3 hospital

wards in Fatmawati Hospital. After 1 month of experiment, the evaluation of

prototype model being done by doing interview to evaluate the quality of model, and

to pick up the recommendation about patient discharge planning model. Beside that,

the study to evaluate the documentation and evaluation by questionnaire also is being

done.

The complete research’s outline can be seen as below:

Problem

identification:

- implementatio

n of discharge

planning

- determinant

factors

The development

of prototype

model of

discharge

planning: slot

system, course

document,

documentation, 4

interactive CD

Trial of

prototype

model for

3 hospital

wards

Evaluation the

model with

questionnaire,

interview, and

documentation

study

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Sample of Research

Sample in this research is all nurses in surgery ward/ Mawar, Medical Rehabilitation

Ward/ Melati, and Postpartum Ward/ Teratai in hospital/ Fatmawati Hospital. Total

sample is 51 people. Fatmawati Hospital is chosen since that hospital has

implemented the hospital information system, included nursing care information

system. While the wards are chosen due to the type of illness of patients in those

three wards are vulnerable and need to have a continuity care at home.

III. RESULTS

A. Univarian Analysis

Problems identification, include the demography data about nurses in Melati,

Mawar, and Gynecology ward (Teratai) in Fatmawati Hospital was done in the

first phase. The results are:

Picture 1 showed that the education level of most nurses is Diploma (82.4%), and

there’re still 5.9% of nurses whose education level still SPK (Sekolah Pendidikan

Keperawatan) or in the same level as senior high school, and just a few who have

become bachelor/ S1 (3.9%).

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Picture 2 showed the distribution of respondent according to their position,

which, most of them are practitioner nurses (72.2%).

Table 1. Respondent Distribution Based On Knowledge about Discharge

Planning

Variable Mean SD SE

Knowledge

Pre

Post

11.16

16.81

2.1

1.9

0.33

0.29

Table 1 indicated the knowledge level about discharge planning, the knowledge

level about discharge planning’s mean before intervention was 11.16 with

standard deviation (SD) 2.1, while mean after intervention was increased become

16.81 with SD 1.9.

Table 2. Respondent Distribution Based On Perception about the Implementation

of Discharge Planning

Variable Mean SD SE

Practical

Pre

Post

50.3

59.32

4.27

3.15

0.65

0.48

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Table 2 showed the perception about implementation the discharge planning, the

discharge planning perception’s mean before intervention was 50.3 with SD 4.27,

while after intervention the mean was increased become 59.32 with SD 3.15.

B. Nursing Problem’s Brainstorming Result

After problem identification process which haven’t showed the result yet, the

brainstorming with nurses and head of ward being done to determine the nursing

problem that often occur and to determine the learning media that will be

developed. The brainstorming results are:

1. Pain

2. Expansion of infection: wound

3. Mobilization

According to the chosen nursing problem, the course document is developed

(attached).

C. Result of Making The Discharge Planning Slot

In this study the discharge planning slot in Fatmawati Hospital was being agreed.

Patient comes

bio, psycho, social, and

spiritual assessment;

including patients’

need for health

education

Nursing

Diagnose, incl.

Health education

Intervention

Implemetation; collaboration

Evaluation

Nursing Documentation

Discharge Planning Slot

Return home,

continuity care:

Clinic/ Community

Health Service/

homecare/ home

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Discharge planning slot started from the patient come. Then the complete

assessment of bio, psycho, social, and spiritual aspect was being held, including

the need for health education and discharge planning process. After the

assessment process, the nursing diagnose include those which related to the need

for health education is being determined. After that, the intervention and

implementation about health education according to Course document that has

being developed before. After implementing the health education, the nursing

evaluation and documentation was being done.

D. Bivarian Analysis

a. Correlation between level of education and knowledge

Table 3. Correlation between Level of Education and Knowledge about

Discharge Planning Before and after being introduced with Model of

Discharge Planning Which is Being Organized and Planned

Variable Mean SD 95% CI p value

Education Level

Before:

SPK

Diploma

S1/Ners

Others

After:

SPK

Diploma

S1/Ners

Others

12

11.39

8.5

115

16.00

16.92

16.50

16.50

1

1.96

2.1

2.5

1.41

1.85

0.71

3.32

9.5 – 14.4

10.7 – 12.00

-10.55 – 27.5

10.7 – 11.8

3.2 – 28.7

16.3 – 17.57

10.14 – 22.85

11.22 – 21.77

0.225

0.887

Table 3 showed there’s no correlation between knowledge and level of

education, both before and after the discharge planning model which being

organizes and planned was being introduced. Looking from the quantity

level, before the program the mean of knowledge level was in Diploma and

after the program was in bachelor level.

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b. Correlation between level of education and perception about the

implementation of discharge planning

Table 4. Correlation between Level of Education and Perception about

Discharge Planning Before and after being introduced with Model of

Discharge Planning Which is Being Organized and Planned

Variable Mean SD 95% CI p value

Education Level

Before:

SPK

Diploma

S1/Ners

Others

After:

SPK

Diploma

S1/Ners

Others

52

50.19

44.5

49.75

57

59.19

62.00

6125

6.5

4.3

12

1.7

3.6

3.16

.

1.2

3.8

0.68

8.5

0.85

2.08

0.53

.

0.63

0.349

0.27

Table 4 showed there is no correlation between level of education and

perception about the implementation of discharge planning; both before and

after the discharge planning model which being organize and planned was

being introduced. The quantity level of those who considered that the

implementation of discharge planning was still below the standard was those

who in bachelor level, and after the program most of who considered that the

implementation of discharge planning was good was those who in bachelor

level.

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c. Correlation between gender and knowledge

Table 5. Correlation between Gender and Knowledge about Discharge

Planning Before and after being introduced with Model of Discharge

Planning Which is Being Organized and Planned

Variable Mean SD 95% CI p value

Gender

Before:

Female

Male

No answer

After:

Female

Male

No answer

49.78

49.62

53.25

59.18

58.42

61.75

0.7

2.27

2.09

3.2

2.5

1.5

48.36

44.24

48.70

0.57

0.97

0.75

0.221

0.37

Table 5 showed there is no correlation between knowledge and gender, both

before and after the model of discharge planning which being organize and

planned being introduced.

d. Correlation between discharge planning based on information technology

media with mean of nurses’ knowledge about DP

Table 6. Correlation between Model of Discharge Planning Which is Being

Organized and Based on Information Technology Media and Mean of

Nurses’ Knowledge about DP

Variable Mean SD SE p value

Knowledge

• Pre

• Post

11.16

16.81

2.1

1.9

0.33

0.29

0.00

Table 6 illustrated that mean of nurses’ knowledge about discharge planning

after the program was better (16.81) with SD (1.9) then before the program

(11.16), SD = 2.1. p value was 0.00, thus it can be concluded that there is an

impact of implementing the model of DP with information technology media

to increase the nurses’ knowledge about DP.

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e. The influence of model of discharge planning based on information

technology media with mean of nurses’ knowledge about DP

Table 7. The Influence of Model of Discharge Planning Which is Being

Organized and Based on Information Technology Media and Mean of

Nurses’ Perception About DP

Variable Mean SD SE p value

The Implementation of

Discharge Planning

• Pre

• Post

50.30

59.32

4.27

3.15

0.65

0.48

0.000

Table 7 illustrated that mean of nurses’ perception about the implementation

of discharge planning after the program is better (59.32) with SD (3.15) then

before the program (50.30), SD = 4.27. p value is 0.00 thus it can be

concluded that there is an influence from implementing the model of

discharge planning with information technology media to increase the nurses’

perception about DP.

E. Interview Analysis

Interview was being held to know and to evaluate the implementation of

discharge planning model with organize slot and based on IT media. The

interview was being done to head of ward, primary nurse representative, nurse

practitioners, patients and families. From the result of interview, it is concluded

that discharge planning media which based on IT was very helpful for nurses in

implementing the education to patients and families in order doing the discharge

planning. This media also help patients and families in understanding the

discharge planning.

The problem that still occurs is the nurse can not assist completely when doing

the discharge planning because of the other duty. The other problem is when

making the course document. Not all the kind of educations need course

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document, but it is enough if the ward already have course document which can

be guidance for whole nurses in giving the educations to patients and family.

The other problem that usually occur is technical problem, which include the

quality of learning media after being used for some times that reduce the

performance thus the quality of learning media need to be increased. Beside that,

the other learning media used to educate to patients and families need to be

develop.

IV. DISCUSSION

Nurse must do discharge planning in order to prepare the patient and family to return

home after being hospitalized. Discharge planning should be structured, started from

the moment when the patient first come to hospital up to the patient return home. The

results of this study indicated there is a correlation between the implementation of

DP model which based on information technology media and nurses’ knowledge

about DP (p = 0.000), and there is correlation between the implementation of DP

model which based on information technology media and the increasing number in

the implementation of DP by nurses. The interview and observation showed that

discharge planning which based on information technology help both patient and

family, and also nurse.

Discharge planning media (CD) is a good device in implementing the discharge

planning. Learning media (CD) simplified the patient and also nurse in implementing

the discharge planning. According the previous theory, the implementation of

discharge planning should be a mechanism to give continuity care, information about

the continuity health need at home, evaluation arrangement, and personal care

instruction (Swanburg, 1999. Page 151). Discharge planning is a professional health

care process for patient and family that also included the interaction between

multidisciplinary. Planning should focus on patient problem, included the act of

prevention, therapeutic, rehabilitation, and general care included non-medical needs.

Discharge planning focus on the process preparing the patient to leave the health

facility/ hospital.

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V. CONCLUSION AND RECCOMENDATION

This study concluded that discharge planning helped patient and family to return

home. By implementing the organized discharge planning, Course Document,

discharge planning is being focused. Patient and family being helped by the learning

media of discharge planning. Learning media (CD) also helped nurse in giving

education to patient. This study also concluded that there is an impact of

implementing discharge planning based on learning media (CD) to increase the

nurses’ knowledge in implementing discharge planning and also having other impact

in increasing the implementation of discharge planning.

Recommendation:

1. Implementation of discharge planning must be done by nurses to help the

patient and family in order prepare to return home. Within the

implementation is also need to be monitored and supervised from the Nursing

Manager so the implementation of discharge planning could be going well.

2. The quality of learning media (CD) need to be improved and the topic in

learning media (CD) need to be added.

3. Further research about the continuity of discharge planning in home care, and

other health services.

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LITERATURE

Carpenito, L.J ( 1995 ). Nursing care plan and documentation nursing

diagnosis and collaboration problem. 2nd

ed. Philadelphia: JB Lippincot

Company

Craven, R.F & Hirnnie, CJ. ( 2000). Fundamentals of nursing human health

And function 3rd

. Philadelphia: JB Lippincot Company

Ellis, J.R & Nowlis, E.A. (1994) Nursing a human need approach. Philadelphia:

J.B Lippincot Company

Fahruji, A dkk, (2001) Nursing project Managemen IRNA B 1 kanan RSCM

Indoensia

Hariyati, R.T (2004). Nursing Journal Indonesia, Vol 8, Corelation of stress

management with preparing and adaptive respone of stroke patients

Ramie, dkk (2006). Nursing project Management: Discharge Palnning in Teratai

Board Fatmawati hospital.)

Swanburg, R (1999).Leadership and Nursing management. Transleter Samba, S.

Jakarta. EGC

Wilkinson, J.M (1996). Nursing process a critical thinking approach. 2nd

Ed

California: Cummings Publishing Company

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CURICULUM VITAE:

Author I

Name : Rr.Tutik Sri Hariyati, SKp., MARS

Educations : Bacelor of Nursing, (University Of Indonesia, 1996)

: Master Management and Hospital Administration, (Public

Health University Of Indonesia, 1999)

Nursing Doctoral candidate, (University Of Indonesia, 2009)

Jobs : Lecturer from Nursing faculty University of Indonesia

(1999- present)

Researcher and eksecutive officer of Research and Public

Services Directorate University of Indonesia (2006-present)

Researchs :

• Corelation of aspec legal knowledge with quality of

nursing documentation, 1999 (funding from URGE)

• Corelation of bladder training with recovery

incontinesia urin, 2000 (funding from University of

Indonesia)

• Study comperative of betadine and cemicitin related

with flebitis (2001-2002, funding from University of

Indonesia)

• Corealtion of stress management with adaptip patient

post stroke (2003, funding from Health Ministry)

• Development prototipe information management

system (2003, funding from education ministry)

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• Preliminary study for implementing distance learning

in Nursing Faculty University of Indonesia (2006,

funding from education of ministry)

• Development learning material with technological

informatics, focus in human basic needs (funding from

world bank, 2006-2007)

• The evaluation of health behavior practice formation

through family empowerment in increasing quality of

Kali Angke enviroment and the impact to diarhea

incidence (2006-2007, Funding from Tzu Chi

University of Thailand)

• Evaluating and developing learning material of

discharge planning (2007, Funding from University of

Indonesia)

• Developing active learning with information

technologies for health care providers in Jakarta,

Banten, Depok, Bekasi and and Bogor Indonesia.(

2007-2008, funding from technology of ministry).

Publication and Training:

- Publication: How about Nursing Information System in

Indonesia ( Indonesia Nursing Jurnal, vol 6, 2002)

- Training: course on basic internet and making

homepage: Hunday Information Technology : Korea,

2003

- Seminar and workshop: Developing information

health curriculum for medicine and nurses: UGM:

October 2004

- Building Indonesia University to deliver training

Distance Learning in Indonesia: QUT: Australia: 21

March-28 October 2005

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- Seminar nasional: policy and management of

Implementing e-learning in higher eduacation:10-11

agustus 2005

- Publication: Using Technology informatics for

education, JKI vol 9 no 1 Maret 2005

- Publication: Nursing Management base on Informatics

system to improve quality of nursing care: We care,

2005

- Publication: copyright: Nursing Information Magament

system No; C00200500331,2005

- Training: Quality Management Sistem: January-March

2007

- Training Audit Internal : November 2008

- Trainer: Nursing Quality Management: Februari 2008

- Publication Draft copy right, 2008: Content

Development base on CD learning media (9 CD)

Author II

Name : Efy Afifah, SKp., M.Kes

Educations : Bacelor of Nursing, (University Of Indonesia, 1993)

: Master of Public Health, (University Of Indonesia, 2003)

Jobs : Lecturer from Nursing faculty University of Indonesia

(1995- present)

Author III

Name : Hanny Handiyani, SKp., M.Kep

Educations : Bacelor of Nursing, (University Of Indonesia, 1993)

: Master of Nursing, (University Of Indonesia, 2004)

Jobs : Lecturer from Nursing faculty University of Indonesia

(1997- present)