Readiness for discharge is a critical nursing diagnosis that evaluates a patient’s ability to safely transition from an acute care setting to home or another healthcare facility. This nursing diagnosis focuses on assessing preparedness, identifying potential barriers, and ensuring proper support systems are in place for a successful discharge.
Causes (Related to)
Readiness for discharge can be influenced by various factors that affect the patient’s ability to manage their care after leaving the healthcare facility:
- Patient’s physical and cognitive status
- Level of independence in activities of daily living
- Availability of support systems
- Patient-specific factors such as:
- Knowledge of medication management
- Understanding of care requirements
- Ability to perform required self-care
- Financial resources
- Transportation access
- Support system factors include:
- Family/caregiver availability
- Home environment suitability
- Access to follow-up care
- Community resources
Signs and Symptoms (As evidenced by)
Assessment of discharge readiness requires evaluation of both subjective and objective indicators.
Subjective: (Patient/Family reports)
- Expressed understanding of care requirements
- Verbalized confidence in the ability to manage care
- Knowledge of medication regimen
- Awareness of follow-up appointments
- Understanding of warning signs
- Comfort with care responsibilities
Objective: (Nurse assesses)
- Demonstration of required skills
- Stable vital signs
- Achievement of treatment goals
- Adequate pain control
- Independence in mobility
- Proper medication management
- Presence of an adequate support system
Expected Outcomes
The following outcomes indicate readiness for discharge:
- Patient demonstrates understanding of discharge instructions
- Patient performs required self-care activities independently
- Support system is in place and prepared
- Follow-up care is arranged and accessible
- Home environment is appropriate for patient needs
- Required medical equipment is available
- Medications are obtained and understood
Nursing Assessment
Evaluate Physical Status
- Assess vital signs stability
- Monitor pain control
- Check wound healing
- Evaluate mobility status
- Assess nutrition status
Review Self-Care Abilities
- Evaluate ADL independence
- Assess medication management
- Check dietary compliance
- Monitor treatment adherence
- Evaluate safety awareness
Assess Support System
- Verify caregiver availability
- Check home environment
- Confirm transportation arrangements
- Review financial resources
- Evaluate community support
Verify Understanding
- Check medication knowledge
- Review care instructions
- Confirm follow-up appointments
- Assess warning sign awareness
- Evaluate emergency plan
Document Progress
- Record skill demonstrations
- Note education completion
- Track goal achievement
- Document support confirmation
- Verify equipment arrangements
Nursing Care Plans
Nursing Care Plan 1: Knowledge Readiness
Nursing Diagnosis Statement:
Readiness for Enhanced Knowledge related to discharge care requirements as evidenced by expressed interest in learning and demonstrated understanding of basic care needs.
Related Factors:
- Cognitive ability to learn
- Motivation to manage self-care
- Available learning resources
- Previous healthcare experience
Nursing Interventions and Rationales:
- Provide structured education sessions
Rationale: Ensures comprehensive coverage of essential information - Use teach-back method
Rationale: Confirms understanding and retention of information - Provide written materials
Rationale: Offers reference for future review
Desired Outcomes:
- Patient will demonstrate understanding of discharge instructions
- Patient will verbalize confidence in self-care management
- Patient will correctly state medication regimen
Nursing Care Plan 2: Self-Care Readiness
Nursing Diagnosis Statement:
Readiness for Enhanced Self-Care related to improving independence as evidenced by demonstration of required care skills.
Related Factors:
- Physical ability to perform care
- Adequate strength and endurance
- Available assistive devices
- Motivation for independence
Nursing Interventions and Rationales:
- Practice care activities with supervision
Rationale: Builds confidence and competence - Demonstrate proper equipment use
Rationale: Ensures safe and effective equipment operation - Assess activity tolerance
Rationale: Confirms ability to perform required tasks
Desired Outcomes:
- Patient will perform self-care activities independently
- Patient will demonstrate proper equipment use
- Patient will maintain safety during activities
Nursing Care Plan 3: Support System Readiness
Nursing Diagnosis Statement:
Readiness for Enhanced Family Coping related to discharge transition as evidenced by caregiver engagement and expressed commitment.
Related Factors:
- Family availability
- Caregiver willingness
- Resource accessibility
- Community support
Nursing Interventions and Rationales:
- Include caregivers in education
Rationale: Prepares support system for care responsibilities - Connect with community resources
Rationale: Establishes ongoing support network - Verify caregiver understanding
Rationale: Ensures adequate support capability
Desired Outcomes:
- Caregivers will demonstrate understanding of care requirements
- Support system will be in place prior to discharge
- Community resources will be arranged
Nursing Care Plan 4: Medication Management Readiness
Nursing Diagnosis Statement:
Readiness for Enhanced Medication Management related to discharge preparation as evidenced by understanding of medication regimen.
Related Factors:
- Cognitive ability
- Medication complexity
- Financial resources
- Available assistance
Nursing Interventions and Rationales:
- Review medication schedule
Rationale: Ensures understanding of timing and dosage - Demonstrate medication organization
Rationale: Promotes proper medication management - Verify medication access
Rationale: Confirms ability to obtain medications
Desired Outcomes:
- Patient will correctly state medication schedule
- Patient will demonstrate medication organization
- Medications will be obtained prior to discharge
Nursing Care Plan 5: Home Environment Readiness
Nursing Diagnosis Statement:
Readiness for Enhanced Home Maintenance related to discharge planning as evidenced by appropriate home preparation.
Related Factors:
- Home accessibility
- Safety requirements
- Equipment needs
- Environmental modifications
Nursing Interventions and Rationales:
- Assess home environment
Rationale: Identifies needed modifications - Arrange necessary equipment
Rationale: Ensures availability of required supplies - Review safety measures
Rationale: Promotes safe home environment
Desired Outcomes:
- Home environment will be prepared for patient needs
- Required equipment will be in place
- Safety measures will be implemented
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Foust, J. B. (2007). Discharge planning as part of daily nursing practice. Applied Nursing Research, 20(2), 72-77. https://doi.org/10.1016/j.apnr.2006.01.005
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Pahlevani M, Taghavi M, Vanberkel P. A systematic literature review of predicting patient discharges using statistical methods and machine learning. Health Care Manag Sci. 2024 Sep;27(3):458-478. doi: 10.1007/s10729-024-09682-7. Epub 2024 Jul 22. PMID: 39037567; PMCID: PMC11461599.
- Patel PR, Bechmann S. Discharge Planning. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557819/
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
