Ethical Discharge Planning for Hispanics

Discharge planning requires a personalized approach. Depending on their circumstances, obviously, patients require individual discharge plans. However, when planning discharges, the discharge nurse should consider the patients’ cultural, socioeconomically, and educational background. Yennurajalingam et al. (2013) revealed Hispanic Americans (HUSAs) composed the majority of the United States’ minorities. Subsequently, discharge planning should understand the level of care in regards to the minority patients’ transfers. Successful discharge planning relies on teaching patients and their family members care plans that will assist the patients as they heal. While some patients may be going home, others are transferred to other departments within the hospital. Nevertheless, regardless of one’s ethnicity, there are moral and ethical considerations behind discharge planning, such as the four fundamental bio-ethical principles of respect for patient autonomy, good will, non-malfeasance and justice. Case management must insure that Hispanics receive ethical and individualized treatment and education regarding their care during the discharge processes.

Centers for Medicare & Medicaid Services (2012) define discharge planning as preparing the patient for another health care setting or home. In order to maintain ethical boundaries, discharge planning considers if the patient understands that he or she has the right to make his or her own decisions regarding health care (Entwistle, Carter, Cribb, & McCaffery, 2010). Secondly, discharge planning is only ethical when it regards good will as more important than financial remuneration. In other words, when planning a patient’s discharge, the discharge nurse cannot make decisions based on the patient’s insurance or finances (American Nurses Association, 2011). In addition, the Code of Ethics, the American Nurses Association (2011) report patient care is only ethical when it makes every effort to do no harm to patients and when it is just for all parties, particularly those who cannot defend themselves.

While each ethical proponent is equally important to the next, cultural differences may impact discharge planning. The Hispanic culture has been identified to depend on an extended family (Rivera & Rogers-Atkinson, n.d.). Close knit families often turn to one another in times of crisis, and medical crises are probably no different. Subsequently, discharge planning should consider the role of family in the Hispanic patient’s life, yet maintain their ethical obligation to patient autonomy.

As an example, discharge planning, and medical care in general, regard the patient’s autonomy. While discharge planning includes after care education, the nurse practitioner cannot influence patients’ overall choices, nor can they make decisions for the patient (Entwistle, Carter, Cribb, & McCaffery, 2010). Subsequently, the patient is solely responsible for his or her after care and lifestyle. In order to understand patients’ decisions, case management and discharge nurses should, ideally, understand cultural differences may arise.

For example, in some scenarios, patients are not discharged to their homes. Instead, discharge planning may involve moving a patient to Hospice. Nevertheless, if a patient needs end of life care, he or she maintains the right to his or her autonomy. Yennurajalingam et al. (2013) found that “older Latinos favored family-centered decision making and limited personal autonomy” (p. 698). In the case a Hispanic patient is discharged to Hospice, the discharge nurse would have to include the patient’s level of family support in their summary because family members may influence the patient’s pain management and treatments (Centers for Medicare & Medicaid Services, 2012). Consequently, the Hispanic patient may be more inclined to ask their family members to make their decisions.

Similarly, traumatic brain injury (TBI) typically involves medical emergencies such as car accidents and other external forces (Janus et al., 2013), but discharge planning continues to provide levels of care based on patient autonomy. Subsequently, such patients depend on the quality of care to improve their quality of life. Janus et al. (2013) reported “previous studies have suggested that ethnicity-related factors can play a role in TBI patient discharge destination” (p. 102). Because the Hispanic patient’s family plays a significant role in his or her decisions, discharge nurses and management should include in their summary the patient’s ability to care for him or herself and the family’s willingness to provide additional care. At the same time, patients who prefer, or are accustomed, to their families making important decisions for them may struggle with patient autonomy. Therefore, through education regarding the patient’s care is one of the most crucial components of discharge planning.

Incidentally, Rose and Haugen (2010) have noted poor discharge approaches may outshine patients’ levels of care. In other words, patients are responsible for their own care upon leaving hospitals, and teaching proper care falls upon discharge planning. However, Rose and Haugen (2010) revealed that some patients felt as though there was poor communication between discharge nurses and doctors and there was “inconsistent dismissal education” (p. 48). In regards to the Hispanic patient, because their families are reported to take large roles in future decisions, the level of communication must extend to the patient’s family. However, it is also up to the patient to allow discharge nurses to disclose personal information. Poor discharges practices do not necessarily reveal a lack of communication, but discharge nurses and care management are ethically bound to protect their client’s confidentiality.

On the other hand, the NHS Institute for Innovation and Improvement identified “Accelerating the discharge process” (Wagstaff, Butler, Kalanovic, & Shepley, 2010) as one of the most pressing issues in discharge planning. Subsequently, discharge nurses are expected to expedite the patient’s discharge, but do so in a matter that it does not affect the client’s health. Self-care and education are two critical features of discharge planning, so in order to accelerate the process, discharge nurses should involve family members but maintain their ethical obligations to the patients.

In sum, cultural values may influence patient’s discharge planning. In the case of the Hispanic patient, research suggests the Hispanic family is close knit and depend one another for support. In the event a Hispanic requires emergency care, standard medical care, or end of life care, appropriate discharge planning will consider the patient’s right to the four fundamental bio-ethical principles, but, at the same time, offer an individualized approach that demonstrates respect and value for the Hispanic culture and their ideals.

References

American Nurses Association. (2011). Code of ethics for nurses with interpretive statements [PDF]. Nursing World.

Centers for Medicare & Medicaid Services. (2012). Discharge planning [PDF]. Department of Health and Human Services.

Janus, T. J., Smith, H. L., Chigazola, A., Wortman, M. R., Sidwell, R. A., & Piper, J. G. (2013). Hospital discharge destinations for hispanic hours and non-hispanic White patients treated for traumatic brain injury. Journal of Trauma Nursing, 20(2), 102-109. doi: 10.1097/JTN.0b013e318296003a

Rivera, B. D., & Rogers-Atkinson, D. (n.d.). Understanding the Hispanic/Latino culture. Culture. Retrieved from http://www.coedu.usf.edu/zalaquett/hoy/culture.html

Rose, K. E., & Haugen, M. B. (2010). Discharge planning: Your last chance to make a good impression. MedSurg Nursing, 19(1), 47-53.

Wagstaff, N., Butler, J., Kalanovic, S., & Shepley, M. (2010). High impact actions: discharge planning: in the first of a series on high impact actions, four senior nurses explain how they have helped to improve discharge planning at their trusts. Nursing Management (Harrow), (3), 12.

Yennurajalingam, S., Noguera, A., Parsons, H., Torres-Vigil, I., Duarte, E., Palma, A., & ... Bruera, E. (2013). A multicenter survey of Hispanic caregiver preferences for patient decision control in the United States and Latin America. Palliative Medicine, 27(7), 692-698. doi:10.1177/0269216313486953