Construction Of A Discharge Plan For Lung Transplant Recipients

Objective:The purpose of this study was to construct a discharge plan for lung transplant recipients(LTRs),and develop various sheets and handbooks needed in the implementation of this discharge plan.It was expected to provide reliable learning materials for LTRs and their caregivers,and provide standard tools for clinical transplant workers,so as to guide the implementation of the discharge plan for LTRs and promote the successful transition of LTRs from hospital to family.Methods:1.The main content of "Discharge Plan for LTRs" were as follows:(1)Assessment of discharge plan:The theoretical framework of this study was constructed according to the Meleis transition theory and Supportive Care Needs Theory.Based on our theoretical framework,the assessment subjects of the discharge plan were LTRs and their caregivers.The assessment content of discharge plan for LTRs should include the general information,discharge needs and knowledge level,and the assessment content of discharge plan for caregivers should contain the general information,care needs,and knowledge level of caregivers.First,the needs of LTRs were explored through literature review and semistructured interview,and then we developed the sheet titled"Assessment Sheet of Discharge Plan for LTRs".Next,the care needs of caregivers were explored through semi-structured interview,and then the sheet titled "Assessment Sheet for Caregivers" were formulated.(2)Formulation and implementation of discharge plan:According to the theoretical framework of this study,the planning stage was to develop plans for LTRs and their caregivers,and the implementation stage was mainly to conduct the health education for LTRs and their caregivers during hospitalization.Therefore,this study first developed the questionnaire titled"Implementation Plan Sheet for LTRs" and "Implementation Plan Sheet for Caregivers",which were formulated according to the content of "Assessment Sheet of Discharge Plan for LTRs"and"Assessment Sheet for Caregivers".Secondly,a semi-structured interview was conducted to investigate the suggestions of transplant clinical workers on the framework of health education.According to the needs of LTRs and caregivers,and the suggestions of clinical workers,we constructed a "framework of health education for discharge plan" in KTRs,Then we searched and analyzed the literatures related to health education for LTRs and form the preliminary content of health education.Finally,we revised the content and formed the final version of health education for LTRs after expert consultation.Then the "Handbooks of Health Education for LTRs(patient version and nurse version)"was made.(3)Evaluation of discharge plan:According to our theoretical framework.the evaluation of discharge plan of LTRs could be divided into two stages:at discharge and after discharge.At discharge,the discharge preparedness,discharge needs and knowledge level of LTRs,and the preparedness,care needs and the knowledge level of caregivers were evaluated.After discharge,the self-management ability and knowledge level of LTRs,and the care ability and knowledge level of caregivers were evaluated.Then we developed the "Record Sheet of Follow-up after Discharge for LTRs" according to "Handbook of Health Education for LTRs".3.The formation of "Discharge Plan for LTRs":After constructing the framework and main content of the discharge plan for LTRs,and developing various sheets and handbooks,the"Discharge Plan for LTRs" was finally formed.Results:1.The results of the main content of "Discharge Plan for LTRs":During the assessment stage of discharge plan,the "Assessment Sheet of Discharge Plan for LTRs" included three parts:the general information,discharge needs,and knowledge level.The discharge needs of LTRs contained informational needs,physiological needs,psychological and emotional needs.spiritual needs,societal needs,and the needs for resource.The "Assessment Sheet for Caregivers" included three parts:the basic information,care needs,and knowledge level of caregivers.The care needs of caregivers contained informational needs,psychological needs,societal needs.and the needs for resource.During the formulation and implementation phase of discharge plan,the "Implementation Plan Sheet for LTRs"included 11 sections of content(medication,complications,diet,rehabilitation,daily life,follow-up,symptom management,psychological and emotional guidance,spiritual support,social support,resource support).The"Implementation Plan Sheet for Caregivers" contained 7 parts(medication,complications,diet,rehabilitation,psychological guidance,social support,and resource support).After searching,screening and evaluating the literature and expert consultation,the content of health education for LTRs discharge from hospital was formed.It was based on four guidelines,three evidence summaries,three expert consensus,seven systematic reviews/Meta-analyses,and twenty randomized controlled trials.The"Handbooks of Health Education for LTRs(patient version and nurse version)”included 11 items(Things to be followed after discharge,medication guidance for lung transplantation,complications associated with lung transplantation,diet and nutrition after discharge,rehabilitation and exercise after lung transplantation,guidance for daily life and home selfmonitoring,symptom identification and response,psychological and emotional adjustment after lung transplantation,social support after lung transplantation,follow-up after lung transplantation in outpatient clinic,and resource recommendation).During the evaluation stage of discharge plan,the following tools were required:the"Discharge Preparedness Scale","Caregiver Preparedness Scale","Record Sheet of Follow-up after Discharge for LTRs","Self-Management Behavior Scale for Transplant Recipients","Knowledge Questionnaire for Kidney Recipients(adapted version)",and "Family Care Giver Task Inventoty".The "Record Sheet of Follow-up after Discharge for LTRs" was needed to develop by ourselves and the final sheet consisted of two parts.The first part was to record the physical and mental conditions,and difficulties of LTRs after discharge.The second part was to ask the recipients about the degree of knowledge understanding.2.The results of constructing "Discharge Plan for LTRs":The content of "Discharge Plan for LTRs" included the purpose of discharge plan for LTRs,principles of discharge plan for LTRs,target patients of discharge plan for LTRs,team member of discharge plan for LTRs,service content of discharge plan for LTRs,procedures of discharge plan for LTRs,sheets and handbooks in discharge plan for LTRs,and quality control of discharge plan for LTRs.There were eight items in total,including ten sheets and two handbooks.Conclusion:In the present study,the "Discharge Plan for LTRs" was constructed based on Meleis transition theory and Supportive Care Needs Theory.The formation process of discharge plan was relatively scientific and rigorous,embodied in three aspects.In the formulation of the program,the relevant evidence of health education for LTRs was systematically searched and evaluated,and the contents were revised after expert consultation.In the process of discharge plan,the standardized process of discharge plan was strictly followed,including three stages:the assessment,formulation and implementation,and the evaluation of discharge plan.In the use of tools,the process of making various sheets and handbooks was scientific and rigorous.Therefore,the program of "Discharging Plan for LTRs" could provide a reference for hospitals to implement discharge plans.