ADMITTING, TRANSFERRING

AND
DISCHARGING A PATIENT
Learning Objectives:
At the end of the lecture the students will be able to:

1. Assist with admissions to a health care facility.

2. Make a person feel welcome and comfortable
during his or her stay at a health care facility.
3. Assist with transfers within a health care facility.
4. Assist to discharge a patient from the institution
following the correct procedure.
KEY TERMS
 Admission: is the person’s formal entry into the
health care setting.
 Transfer: moving the patient from one unit of the
hospital to another.
 Discharge: is the formal release of the person from the
health care setting where she is receiving care.
ASSISTING WITH
ADMISSIONS
CHILDREN
Children might wonder what might happen to
them and may be frightened of the equipment and
noises of the environment. Allow parents to stay
with the child as much as possible. Explain the
things to the child in simple language. Let the
child touch and explore as much equipment as
possible.
ADOLESCENT
For adolescent, avoid the use of medical jargon.

ADULT
For adults and elderly, allow them to make decisions as
possible. Explain things in terms that they can understand
and allow time for questions and concerns.
When a person is admitted to a health care facility,
you and other members of the staff follow a planned
series of events. To get ready for a person’s arrival,
follow the admission sheet and instructions from the
nurse. Find out whether the person has any special
needs or requirements. Gather and bring to the
person’s room the equipment and materials you need
for the admission process, such as a blood pressure
cuff and stethoscope and thermometer, and a personal
belongings inventory sheet.
Put a pitcher of water and a cup on the bedside table
(unless fluid restrictions are in effect). Provide a
gown, a washcloth and towel, equipment for personal
care (such as a wash basin, an emesis basin or a
bedpan) and toiletry items (such as soap and
toothpaste). Open the bed by fan-folding the top
linens down to the bottom of the bed. If the person
will be arriving on a stretcher, you may need to
prepare a surgical bed instead.
Welcoming the Person
A nurse, with assistance from other members of the health
care team (such as the admissions coordinator or social
worker) manages the admission process, including any
necessary paperwork. You may be asked to help escort the
person to her room. However, if you are meeting the
person for the first time without a formal introduction,
knock on the door, smile and greet her with a friendly
“hello.” Make the person feel welcome by introducing
yourself. To help lessen feelings of anxiety about the
health care experience, explain what is happening and
what is going to happen.
Welcoming the Person
Next, wash your hands. Check the person’s name
band or photo identification. If someone has come
from a hospital into a nursing home, remove the
hospital name band if this has not been done already.
Explain that you are the nurse assistant who will be
providing care. Ask the person what she would like to
be called, and be sure not to use her first name unless
she gives you permission. Introduce her to any
roommates. Ask her if she needs to use the bathroom
before continuing the admission process.
Welcoming the Person
One way to learn more about the person in your
care is to ask questions. Although the nurse is
responsible for completing the formal health history
interview, you can encourage the person to tell you
about anything that would make her stay more
comfortable. Ask about special preferences, habits
or problems. One way to ask questions is by
working your way from head to toe. If you refer to
the admission form while you ask questions, you
can see that it often prompts you to work this way.
Welcoming the Person
For example, you may ask: “Do you wear glasses?
Is there anything special that I should know about
them? Do you have a hearing aid? Is there
anything special that I should know about it or
about your hearing in general? Do you wear
dentures? Do you have trouble sleeping at night?”
Continue asking similar questions about diet,
mobility and elimination. Record the answers and
report important information to the nurse.
Welcoming the Person

Admission to a health care facility can be very

stressful for the person and the family. Be aware
that the person’s first impressions of the facility
may influence how she feels about being there.
First impressions can also influence feelings of
family members about the care that their loved one
will receive while in the facility.
Welcoming the Person

Your approach and consideration can go a long

way toward making a good first impression and
giving the person and family confidence in the care
that will be provided. To help the person and
family feel more comfortable, take the following
steps:
Welcoming the Person

■ Each time you greet the person, smile and call

her by her preferred name.
■ Make an effort to get to know the person as an
individual. Ask the person and her family
members about the person’s preferences, and take
these preferences into account when you provide
care
Welcoming the Person
■ Welcome information that the family provides
(for example, about care techniques that they have
found to be effective), and use this information to
guide the care that you give.
■ Always include the person in conversations that
concern her.
■ Before you leave the person’s room, always ask
if there is anything else that the person needs.
Looking After the Person’s Belongings
As part of the admission process, you may be
responsible for filling out a personal belongings
inventory sheet; an envelope for valuables may be
included. When you describe belongings such as
jewelry, use words that do not assign value to the
object. For example, describe a ring as “a yellow
metal ring with one clear stone,” and be careful
not to use words such as gold, silver or diamond.
Looking After the Person’s Belongings
When you describe a watch, write down the brand
name found on the watch face. Encourage the
person to send as many valuables home as
possible. If necessary, you can arrange for
valuable items to be locked in the facility’s safe.
After you complete the inventory sheet, give it to
the nurse.
Looking After the Person’s Belongings
If you work in a nursing home, you may need to
label the person’s clothing with the person’s name.
In some facilities, other members of the health
care team, such as the social worker or laundry
aide, handle this responsibility. If you have this
responsibility, follow your employer’s policies and
procedures for labeling the person’s clothing.
 Measuring and Recording Vital
Signs, Weight and Height
When a person is first admitted to a health care
facility, you will measure and record the person’s vital
signs, height and weight. These initial measurements
help the health care team determine a point of
reference, or baseline, for the person. Subsequent
measurements can be compared with the baseline
measurements to track changes in the person’s
condition. Perform your tasks in a warm, unhurried
manner to help the person relax and feel better about
being in a health care situation.
 Familiarizing the Person with the
New Surroundings
Another important part of the admission process is
familiarizing the person with her new environment. Explain
the facility’s policies, schedules and visiting hours to the
person and her family. Show the person how the call signal
works, and ask her to demonstrate that she understands how
to use it. Demonstrate how to adjust the bed and raise and
lower the over-bed table. If any other equipment is in the
room, such as a TV or a phone, you should also ensure that
the person knows how to use it.
 Familiarizing the Person with the
New Surroundings
When a person is being admitted to a nursing
home, offer to take her and her family on a tour of
the unit or facility. If the person wishes to go,
introduce her to other members of the staff and
other residents. After the tour, help the person get
comfortable in her room and put the call signal
within her reach. Ask her whether she needs
anything. If not, wash your hands and tell her
when you will return.
 Familiarizing the Person with the New
Surroundings
When you have finished your duties related to
admitting the person to the facility, report to the
nurse. Be sure to include your observations about
the person’s physical condition, emotional status
or both in your report to the nurse. room or unit.
 Familiarizing the Person with the New
Surroundings
A resident of a nursing home may also be
temporarily transferred from the nursing home to a
hospital for treatment of an acute condition, such as
pneumonia. Any move may have an emotional
impact on the person. When you assist with
transfers, encourage the person to talk about his
feelings and reassure him, if necessary.
 Patient Plan of Care
Upon admission or shortly thereafter, an
individualized patient care plan is written by a
registered nurse. This plan serves as a course of
action to assist the patient to achieve optimum
wellness. They provide a structure for assessing,
planning, implementing and evaluating
individualized care.
 Function of Nursing Assistant in
Patient Plan of Care

The part of the plan of care most directly involving

the nursing assistant are the activities of daily
living, direct bedside care, and making and
reporting objective, factual observations.
ASSISTING WITH
TRANSFERS
Transfers often occur because a person’s condition
gets better or worse and her health care needs
change. Most transfers take place within a facility,
to a different room or unit. A resident of a nursing
home may also be temporarily transferred from
the nursing home to a hospital for treatment of an
acute condition, such as pneumonia. Any move
may have an emotional impact on the person.
When you assist with transfers, encourage the
person to talk about his feelings and reassure him,
if necessary.
Transfers Within the Facility
When you assist with a transfer within the facility, you
will need to help the person pack her belongings. After
you wash your hands and greet the person, explain that
you are going to help her get ready for her transfer. As
you help gather her things, talk with her about the
transfer and answer any questions that she may have.
Pack personal care equipment, such as the wash basin
and bedpan, in addition to the personal belongings.
After you complete these tasks, wash your hands. If
applicable, give the person time to say good-bye to her
roommate.
Transfers Within the Facility
Ask the nurse for the records and charts that must
go with the person, and ask if the receiving unit
has been notified that the transfer is in process.
The nurse will notify the receiving unit and give
the receiving nurse a report of the person’s
condition. The time of the person’s arrival on the
new unit may need to be adjusted so that the
receiving staff is available to receive her.
Transfers Within the Facility
Help the person into a wheelchair. (Some facilities
prefer that you move the person in her bed from
one room to another.) Ask a co-worker to help
you, if necessary. Move the person and her
possessions to her new room, and introduce the
person to her new nurse and nurse assistant.
Report important information, as necessary.
Transfers Within the Facility
To help the person make a comfortable transition
from one room or unit to another, and as a
courtesy to the new nurse assistant, share the
information that you have about the person’s
preferences and care needs with the nurse assistant
who will take over. You may also stay and assist
the new nurse assistant with some of the tasks
related to helping the person get settled in her new
environment. Then, spend a few minutes talking
with the person about how you enjoyed helping
her, and wish her well in the future.
Transfers Within the Facility
After you return to your own unit, report to the
nurse that the person’s transfer has been completed.
Provide details such as the time of the transfer and
the mode of transportation, and share your
observations about the person’s physical or
emotional status. Then, follow your employer’s
policy for preparing the room for use by another
person. Remove any equipment that the person did
not take from her old room. If she was not moved in
her bed, remove dirty linens. After you finish these
tasks, wash your hands.
Temporary Transfers
A resident of a nursing home or a home health client
may need to be transferred to another type of health
care facility to receive care for an acute medical
condition. This type of transfer is called a temporary
transfer, because the person is expected to return to the
nursing home or to his own home after receiving
treatment for the acute medical condition. If the person
is a resident of a nursing home, a bed hold may be put
into effect for the time that the person is expected to be
away. The bed hold reserves the person’s place at the
nursing home.
Temporary Transfers
When you assist a person with a temporary
transfer, pack only the clothing and belongings
that the person will need for a hospital stay (for
example, a robe, slippers and personal items such
as a comb, brush, toothbrush, eyeglasses and
dentures). If time and circumstances permit, help
the person bathe. Help the person dress. Clothing
that is easy to remove is usually best.
Temporary Transfers
Remember that the person will most likely be
asked to remove jewelry, so keep accessories to a
minimum. If the person is a resident of a nursing
home, valuable belongings may be placed in the
facility’s safe or another secure area until the
resident returns. Follow your employer’s policy
for listing and storing the person’s personal
belongings while the person is away.
ASSISTING WITH
DISCHARGE
Written permission from a doctor is required for
the patient to be discharged, or officially
processed out of the health care institution. Your
supervisor will tell you when the doctor has
ordered that the patient is to be discharged.
CHILDREN

For children, this might mean explaining in simple

terms the healing process at home and any
instructions. Most care needs will be handled by
their parents.
ADOLESCENT

Adolescent will want to know more about what to

do at home and about restrictions. Avoid the use of
medical jargons. Answer questions directly with
the adolescent and not just with the parents.
ADULTS

When discharging the adult and elderly patient,

consider their lifestyles and learning preferences.
Emphasize how the information will help them
and allow time for questions.
A person is discharged, or released, from the
health care setting when the care provided by the
current health care setting no longer meets the
person’s needs. For example, a person may be
discharged from a hospital to a sub-acute care
facility, a nursing home or his own home as his
condition improves and he no longer requires
hospital care.
 DISCHARGE AND HEALTH
TEACHING

Teaching patients how to care for themselves at

home is the responsibility of the entire nursing
team.
 DISCHARGE AND HEALTH
TEACHING
The following are the information included in the
discharge instructions and patient health education
plan.
1. Explanation of the patient’s disease
 History and/or explanation of disease
Signs and symptoms expected and those not
expected
What to report to the physician
 DISCHARGE AND HEALTH
TEACHING
2. Explanation of medications as ordered by the
physician
Name of the medication
Dose: who much the patient needs to take
Correct time to take the medication
Signs and symptoms of the side effects of the
medication
What to report to the physician
 DISCHARGE AND HEALTH
TEACHING
3. Explanation of treatment ordered by the
physician
purpose of treatment
Time of treatment
How to perform treatment
Return demonstration of the treatment
What to report to the physician
 DISCHARGE AND HEALTH
TEACHING

4. Explanation of nutrition and diet

type of diet ordered by the physician
Food allowed and not allowed for the diet
Amount of food to be consumed
 DISCHARGE AND HEALTH
TEACHING

5. Explanation of care in the environment

Elimination of hazards in the home environment
Available transportation to the physician’s office
 DISCHARGE AND HEALTH
TEACHING

6. Explanation of progression of ADL

 outline ADL for the first 2 weeks following
hospitalization, with progressive activities
Signs and symptoms of inability to perform ADL
What to report to the physician
 DISCHARGE AND HEALTH
TEACHING

7. Explanation of future appointment that have

been made with the physician’s clinic
 time and date of appointment
Name of physician or clinic
Phone number and address of physician and
clinic
The reason why these future appointments are
necessary for follow-up care
 ASSITING THE PATIENT WITH
DISCHARGE
On the day that a person is ready to be discharged
from the facility, help her gather all her belongings
and pack her suitcase. Check items against the
personal belongings inventory list to make sure
that she has everything she brought with her.
Check with the nurse to make sure that the proper
forms are filled out and ready to go with the
person.
 ASSITING THE PATIENT WITH
DISCHARGE
Help the person into a wheelchair or onto a stretcher
and transport her to the exit. Tell the person how
much you have enjoyed helping her, and wish her
well in her recovery. If the person is being
transported by ambulance, introduce the person to
the ambulance crew. If necessary, help the
ambulance attendants move the person into the
ambulance. Make sure that the person’s belongings
and forms are placed in the vehicle with the person.
 ASSITING THE PATIENT WITH
DISCHARGE
Report to the nurse that the person’s discharge has
been completed. Provide important information,
such as the time of the discharge, mode of
transportation, how the person responded and any
important observations.
 ACTIVITY 1:

ROLE PLAYING
Group 1
Create a scenario wherein you
can present the proper way on
how you will assist the patient
with ADMISSION
Group 2
Create a scenario wherein you
can present the proper way on
how you will assist the patient
with TRANSFER
Group 3
Create a scenario wherein you
can present the proper way on
how you will assist the patient
with DISCHARGES.
 ACTIVITY 2:

ANSWER THE FOLLOWING

QUESTIONS
1. Mr. Mendez is being transferred out of your unit
to the intensive care unit (ICU) because his
condition has worsened. He confides in you that
he is very frightened about his health and worried
about the change in the nursing staff. How would
you respond to Mr. Mendez? What can you to do
to help?
2. You are introducing yourself to Mrs. Woods, a
new resident in the nursing home. She tells you
that she dislikes the plainness of the room and is
worried that she will be lonely here. She also tells
you that she really wanted to live with one of her
sons’ families. What can you do to alleviate her
concerns? How can you help her to feel welcome
and at home in her new environment? How would
you respond to her comments about her sons?