Road to recovery

Government Policy into Action: Good Discharge of Patients Leaving General Hospitals, Part 1

This article summarises the Department of Health Circular (89)5 which requires health authorities to ensure good arrangements for patients' discharge from hospital. It reviews the literature on this topic and compares what has been said with what has been meant when professionals have written about their participation in the process of discharge. The second article deals with models of policy implementation by which the policy process can be analysed in order to inform implementation methods. It describes how implementation has been tackled so far in one health district.

A study of the impact of discharge information for surgical patients

AIM OF THE STUDY

To establish whether the routine information surgical patients receive about the management of pain and wound care during their hospitalization is sufficient for them to care for themselves without seeking assistance from a health professional or health care agency.

BACKGROUND

While there has been considerable evidence suggesting cost benefits of discharge information the health care environment is constantly changing. Contemporary issues such as increased patient participation, extensive use of technology, reduction in health care expenditure, and greater awareness of consumer rights necessitate further inquiry into the appropriateness of discharge information.

METHOD

One hundred and fifty-eight adult patients discharged within a week of their operation participated in the study. A written questionnaire was distributed within 24 hours prior to discharge and a telephone interview conducted 1 to 2 weeks after discharge. At the time of discharge the majority of patients had received information.

FINDINGS

Those patients who had received information were less likely to access a health facility than those who had not received information. However, the telephone interview, revealed that there was no evidence that patients who believed they were well informed within 24 hours of discharge about the management of their wound, still felt well informed 1 to 2 weeks later.

CONCLUSION

Nurses need to be aware that patients who leave the hospital with little or no discharge information may not be confident in the management of their health condition and therefore may access a health facility, if even just for reassurance.

Research in intensive care nursing

The results of a questionnaire study about intensive care nursing in Finland indicate that the chief problems in intensive care nursing are concerned with staff coping resources, quality development and patient experiences. Questions on staff stress and coping have been researched quite extensively. Earlier studies have described intensive care nursing as highly stressful and pointed to numerous problems related to coping. It is clear that intensive care nursing warrants closer attention in research.

Preoperative patient teaching in ambulatory surgery settings

The researchers conducted this descriptive replication study to identify preoperative teaching content deemed important by patients and nurses in ambulatory surgery settings. Thirty ambulatory surgery patients and 29 perioperative nurses participated in the study, which was conducted at a midsized hospital in the southeastern United States. Patients ranked situational information (eg, explaining activities, events) as the most important teaching content areas, whereas nurses ranked psychosocial support (eg, dealing with worries, concerns) as the most important. Patients preferred to have teaching conducted before they were admitted for ambulatory surgery, whereas nurses believed that some teaching could take place after admission. The study results suggest that addressing patients' priorities and initiating teaching earlier in the perioperative process is crucial to ambulatory surgery patients' postoperative outcomes.

Understanding the pre-operative information needs of patients and their relatives in intensive care units

A descriptive study was undertaken to assess the pre-operative information needs of patients and relatives admitted electively to intensive care units (ICU) following surgery. A convenience sample of five patient and relative groups were interviewed pre- and postoperatively. The interviews were analysed using thematic content analysis (Burnard 1991). The findings showed that the patient and relative dyads' 'expressed worries' related to the anaesthetic, surgery and ICU; patients stated that their relatives were more anxious than they were. The findings are similar to the pre-operative 'information needs' in which patient and relative dyads sought information regarding the surgery, visiting and treatment regimes in ICU. The most important information need identified was 'the need to understand the operation'. From the findings it was concluded that the nature of the information sought by ICU patients and their relatives was associated with perceived harms and threats related to the hospitalisation. Information which was structured to meet individual needs reduced anxiety and increased satisfaction with the information provided.

Spouses' perceptions of readiness for discharge after cardiac surgery

The purpose of this study was to describe spouses' perceptions of readiness for discharge after a partner's coronary artery bypass graft (CABG) surgery. An exploratory design was used to address the research questions. Six weeks after discharge, a nonrandom sample of 67 female spouses responded to open-ended questions about discharge readiness. The data were examined using content analysis. One hundred eighty-six statements were coded from the 67 questionnaires. Forty-two women (62%) reported they felt prepared for discharge. Four key people were identified as very helpful to spouses at discharge: nurse, physician, immediate family member, and friends who have had the same experience. Availability of social support, use of coping strategies, personal resources, and knowing what to expect were the major factors that influenced spouses perceptions of readiness for discharge.

The evaluation of a community coronary specialist nursing service in Northern Ireland

Providing an efficient service depends partly on evaluation, which itself should take into account, amongst other things, the clients' views. This study set out to evaluate clients' perception of a coronary specialist nursing service (CSNS) in one area health board in Northern Ireland. Postal questionnaires were sent to a random sample of 70 clients of the CSNS. Results showed that the majority expressed satisfaction with the service, as well as with the information they received prior to discharge into the community. Their responses provide food for thought to those involved in the provision of such services.