4.4.6: FRAME 6- Evaluate Outcomes

It is post-op day 7, and Jacklyn is being discharged. She has made significant progress over the past 3 days and is able to ambulate without needing breaks or becoming short of breath. She is actively participating in cardiac rehab daily and plans to continue as an outpatient. Jacklyn’s mental status has improved, and she has utilized resources provided to her during the hospital stay. Jacklyn is sharing her milestones journal and discussing short- and long-term goals with the telemetry nurse prior to discharge.

Evaluate Outcomes

QUESTION: Multiple Response Select All That Apply

Scoring Rule: +/-

The nurse is pleased to review Jacklyn’s journal and goals. As the nurse, determine which of the goals created by the client demonstrates a lack of understanding and needs follow-up.

	Goal Statement
❑	Discuss cardiac rehab schedule with son for transportation needs.
❑	Try to make it to every session
❑	Talk to my boss about job responsibilities, see if there is another position that does not require as much lifting and pulling
❑	Try to find support outside of my son. Join the support group of fellow patients and caregivers who have recovered from heart-related events
❑	Walk 2 miles by the end of the month

Putting It All Together

DEBRIEF

Comparing observed outcomes against expected outcomes is an essential nursing action prior to discharge. This will help the nurse collaborate with the client to identify improving/declining/unchanged status and evaluate the client’s knowledge of their disease process, recovery, medications, and restrictions before discharge. As the nurse reviews Jacklyn’s Milestone Journal, it is evident that the client is in a better mental and emotional state than she was a few days ago. Jacklyn articulates signs of hope and continued progress for the future. The nurse would want to further discuss the timeframe for Jacklyn’s goal of walking 2 miles by the end of the month, knowing Jacklyn is being discharged on July 28.

It is also important for the nurse to realize that when clients are discharged, they are leaving a controlled environment and entering a more uncontrolled environment that is heavily influenced by SDOH. Allowing the client to identify barriers they will face upon discharge will assist the nurse in identifying possible resources, guidance, and tools to support the client’s forward post-op progression and avoid readmission to the hospital. The nurse can use varied teaching strategies when assessing the client’s understanding. Spending valuable time assessing the effectiveness of the education will help the nurse understand ways to improve health literacy and client understanding before discharge to avoid readmission back to the hospital.

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

Depression in the United States is increasing across all races and ethnicities and is attributed to multiple SDOHs (Yelton et al., 2022). Healthy People 2030 aims to ensure “healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death” and acknowledges the need to achieve health equity through structural and behavioral intervention. Health People 2030 categorized SDOH into five domains Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Within these domains are several potential risks and protective factors for mental health outcomes relating to access, quality, and safety of material, social, educational, occupational, civic, and health-related resources (Yelton et al., 2022). Systemic racism, implicit bias, reluctance to refer, segregation, and inequity for protective factors for specific groups or communities can contribute to adverse SDOH outcomes and depression/depressive symptoms.

Social change and action to increase equity and provide a voice to populations whose otherwise voices are not heard can be influenced by the nurse’s advocacy, engagement in the legislative process, and participatory research promoting dialogue that shares stories about important issues affecting rural and other marginalized individuals or groups.

What Do You Think About?

1. What SDOH will impact Jacklyn as she goes back home and is discharged from the hospital?
2. What resources could be given or shared with Jacklyn prior to discharge?
3. Describe actions a nurse can take to addressed SDOH and related mental health outcomes?