"Preparing Patients to Care for Themselves" (Viewpoint, July) reflects many of the thoughts and experiences I have had as a parish nurse.

Discharge planning should start on the day of admission-every nurse has heard this, but I don't think I have ever seen it in practice. This is especially evident when a home health nurse arrives to find that the patient and family know almost nothing about what to do next.

Patients usually have to wait (sometimes for hours) for a nurse to talk to them in preparation for discharge from the hospital. When the nurse arrives to read the discharge orders, the patient is asked to sign an acknowledgment that she or he understands them. Typically, as the patient is signing the form, the nurse asks, "Do you have any questions?" Wouldn't it be better if the nurse asked the patient and family how they planned to act on these orders when returning home?

Virginia M. Wepfer, MSN, RN

Lake Milton, OH