The challenges of improving discharge planning in Sweden and the UK: different but the same

Healthcare Managers' Experiences of Leading the Implementation of Video Conferencing in Discharge Planning Sessions: An Interview Study

This article describes healthcare managers' experiences of leading the implementation of video conferencing in discharge planning sessions as a new tool in everyday practice. Data collection took place through individual interviews and the interviews were analyzed using qualitative content analysis with an inductive approach. The results indicate that managers identified two distinct leadership perspectives when they reflected on the implementation process. They described a desired way of leading the implementation and communicating about the upcoming change, understanding and securing support for decisions, as well as ensuring that sufficient time is available throughout the change process. They also, however, described how they perceived that the implementation process was actually taking place, highlighting the lack of planning and preparation as well as the need for support and to be supportive, and having the courage to adopt and lead the implementation. It is suggested that managers at all levels require more information and training in how to encourage staff to become involved in designing their everyday work and in the implementation process. Managers, too, need ongoing organizational support for good leadership throughout the implementation of video conferencing in discharge planning sessions, including planning, start-up, implementation, and evaluation.

Framing the implementation process of video conferencing in discharge planning-According to staff experience

Challenges of improving discharge planning have been an area of concern for many years, including problems related to the lack of time for professionals to participate. In a county in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation of the professionals. To examine the implementation process, interviews were conducted with the implementers, who were project leaders, discharge planning coordinators in the hospital, and in home-care. The interviews were analyzed qualitatively, using directed content analysis with a deductive approach to a theoretical framework that was composed from theories about implementation processes to be suitable for the healthcare sector, consisting of the factors: implementation objects; implementation actions; actors; users; inner context and outer context. The results of this study are consistent with the framework but with the addition of a new dimension-time, i.e. time to prepare; time to understand; time to run through and time to reflect. It is suggested that implementation frameworks are useful when IT is introduced in healthcare. Framing the implementation process supports the exposure of factors and highlights relationships and states of dependence between those factors which may affect implementation.

Geriatric Rehabilitation: Elderly Clients' Experiences of a Pre-discharge Occupational Therapy Group Programme

This study describes how elderly people, temporarily living in a pre-discharge community rehabilitation centre, may experience participation in an in-patient occupational therapy programme built around group activities. The group activity programme was comprised of five sessions, each focusing on a theme chosen to encourage reflection and mutual sharing of experiences and support. Data were collected through interviews with each of the three participants immediately after each of the five group sessions. The resultant 15 interviews were analysed by adopting a Grounded Theory approach. The results show that the ways in which the participants experienced participating in the group activity programme can be described from two distinct core categories: experiences of activation and experiences of transformation . The category of activation emerged from their experiences of a creative force whilst engaged in performing the activities and from their discovery that the group was a good place for learning . Engagement in the group activities also seemed to bring about a transformation in the participants in that their experiences triggered reflection and adaptation , which contributed to a change in attitude and a personal synthesis where their new discoveries were internalized. The study shows the potential a group activity programme in occupational therapy has in triggering an adaptational and reflective process within elderly people facing discharge from hospital. Hence, group activity interventions in occupational therapy are suggested as one possible way to support the elderly person in the discharge process from hospital to the home.

Elderly persons' experiences of participation in hospital discharge process

OBJECTIVE

The purpose of this study was to describe older hospital patients' discharge experiences on participation in the discharge planning.

METHODS

A sample of 254 patients aged 80+ was interviewed using a questionnaire developed by the research team. Data were collected by face-to-face interviewing during the first two weeks following patients discharge from hospital.

RESULTS

In spite of their advanced age the patients in this study did express a clear preference for participation. However, there were no significant correlation between patients' wish for participation and experienced opportunity to share decisions. Hearing ability was the only significant factor affecting the chance to participate, whereas sociodemographic factors did not significantly affect on the likelihood participation the discharge process.

CONCLUSION

The actual practice of involving old people in the discharge process is not well developed as experienced by old patients themselves. The fact that factors like gender and education have little influence on participation in the oldest patients might be related to age; when you get old enough, old is all that is 'visible'.

PRACTICE IMPLICATIONS

To determine the extent of elderly patients' desire to participate, one must actively look for it both through research and in the hands-on process of discharge.

Emergency department nurses' understanding and experiences of implementing discharge planning

AIM

This paper is a report of a study conducted to describe emergency department nurses' understanding and experiences of implementing discharge planning.

BACKGROUND

Discharge planning in the emergency department is an important issue because of increased healthcare costs and greater emphasis on continuity of care. When executed as a collaborative process involving a multi-disciplinary team with the patient and family, discharge planning provides continuity of care for patients, less demand on hospitals, improvement in community services and in the services of other healthcare organizations.

METHOD

The qualitative approach of phenomenography was used in this study. Thirty-two emergency department nurses were recruited between July and September 2005. Semi-structured interviews were conducted.

FINDINGS

From interviewees' descriptions of implementing discharge planning, six categories were established: implementing discharge planning as 'getting rid of my patients', completing routines, being involved in patient education, professionally accountable practice, autonomous practice and demonstrating professional emergency department nursing care. The referential meaning of implementing discharge planning 'in the outcome space' was the professional commitment to emergency department provision of effective discharge services.

CONCLUSION

The results of this research contribute to knowledge of emergency department nurses' experience in the implementation of the discharge planning process. Key requirements for the provision of manageable discharge services both in Taiwan and worldwide highlighted by this study include adequate workloads, sufficient time, clear policies and standards of discharge planning and enhancement of professional commitment.

'Out of Hospital': a scoping study of services for carers of people being discharged from hospital

Successive government policies have highlighted the need to inform and involve carers fully in the hospital discharge process. However, some research suggests that many carers feel insufficiently involved and unsupported in this process. This paper summarises a scoping review to identify what the UK literature tells us about the service provision for carers, and its effectiveness, around the time of hospital discharge of the care recipient, and also describes a mapping exercise of the work currently being done by Princess Royal Trust for Carers Centres in England to support carers around the time of hospital discharge. The restriction to UK literature was dictated by the nature of the project; a modest review carried out for a UK-based voluntary sector organization. Fifty-three documents were reviewed, of which 19 papers (representing 17 studies) were reporting on primary research. As only five of these studies actually involved an intervention, it appears there is very little research from the UK which evaluates specific interventions to support carers around the time of hospital discharge of the care recipient. While the mapping exercise showed that in some areas there are services and/or initiatives in place which have been designed to improve the process of discharge for carers, in many places there is still a gap between what policy and research suggest should happen and what actually happens to carers at this time. Even where services and initiatives to support carers through the discharge process exist, there is only limited evidence from research or evaluation to demonstrate their impact on the carer's experience. Further research, both quantitative and qualitative, is required to address these areas and enable commissioners, providers and carers' organizations to work together towards a service in which patients and carers alike receive the support and help they need at this significant time of transition.

Key factors impeding discharge planning in hospital social work: an exploratory study

Despite its long historical tradition in Northern Ireland, there is a dearth of research studies on the role of hospital social work and the professional challenges involved at the health and social care interface. This is the first small-scale exploratory study in Northern Ireland that sought to identify the key factors that hospital social workers perceive as impeding their practice in the discharge planning process. A 15-item postal questionnaire was developed and distributed to 30 hospital social workers from four hospital social work departments in a city in Northern Ireland. The study group comprised social workers based in a range of hospital directorates who had differing levels of hospital social work experience. Data generated from the questionnaires suggested that deficits in community resources impacted most negatively on social workers' practice in discharge planning. The length of time respondents had been in their current post was also shown to influence their responses to the perceived impediments in their discharge planning role. The implications of the study and recommendations are discussed in relation to in-service training, social work practice and continuing education in Northern Ireland.

Critical care nurses' beliefs about the discharge planning process: a questionnaire survey

AIM

To report on the beliefs of critical care nurses with regard to the discharge planning process, in Victoria, Australia.

METHODS

An exploratory descriptive design was used. A total of 502 Victorian critical care nurses were approached to take part in the study. A total of 218 eligible participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using descriptive statistics.

RESULTS

The current discharge planning processes are ad hoc and influenced by patient acuity. Critical care nurses believe that workload issues, unplanned discharges and inadequate communication contribute to difficulties implementing the discharge plan.

How do critical care nurses define the discharge planning process?

BACKGROUND

Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area.

AIM

The study reported here is part of a larger thesis exploring critical care nurses' perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked.

METHODS

Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies.

FINDINGS

Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient.

CONCLUSION

The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of critical care nurses with regard to the underlying principles of the discharge planning process.

The impact of a liaison nurse on ICU nurses' perceptions of discharge planning

The objective of the study was to examine the impact of a discharge liaison nurse on intensive care unit (ICU) nurses' perceptions of discharge planning. The discharge liaison nurse coordinated the discharge of patients from ICU to the ward, assisted with hospital discharge, provided clinical teaching and support to both ICU and ward nurses and supported patients and families during hospitalisation. A block intervention design was used. All ICU nurses within one Australian teaching hospital were surveyed prior to and following the implementation of the discharge liaison nurse. Measures included the perceptions of discharge planning scale and the general perceived self-efficacy scale. Following implementation of the liaison nurse, less nurses perceived that discharge planning in the ICU was premature (chi2(2, n=117)=7.759, p=0.021) and that ICU nurses lack an understanding of the discharge planning process (chi2(2, n=118)=15.557, p<0.001). Discharge planning was more frequently seen as the responsibility of the bedside nurse (chi2(2, n=115) =15.270, p<0.005) but there was greater recognition of discharge planning as a time consuming process (chi2(2, n=117)=8.560, p=0.015). Self efficacy in relation to discharge planning did not change over time. Some support was found for the role of the discharge liaison nurse in promoting attitudinal change towards discharge planning in the ICU. Future research is needed to investigate the processes by which the liaison nurse fosters attitudinal change and to document the actual discharge planning practices undertaken in ICU.

ICU nurses' perceptions of discharge planning: a preliminary study

The role that intensive care unit (ICU) nurses could play in hospital discharge planning remains relatively unexplored. Using a case study, all ICU nurses in one hospital were surveyed about their perceptions of their role in the discharge process. Over 70% of the 58 nurses who responded thought that discharge planning was both appropriate in the ICU and not premature. However, several obstacles including patient acuity, time constraints and limited experience with this process were evident. While ICU nurses are aptly placed to manage discharge planning, they cannot be expected to undertake this important role without a systematic approach to its implementation.

Discharge of frail older people from acute hospitals across Europe

Over the last few years the number of elderly patients in acute hospitals throughout Europe has risen dramatically. The pressure on hospital beds leads to earlier discharge and the task of sending patients home from hospitals is becoming more complex. The provision of health and social services is organized in different ways all over Europe. Therefore, it would be of interest to know more about how different kinds of systems support the professional carers in their effort to satisfy the needs which older people and their significant others experience in the discharge process. A pilot study was set up mainly to provide information on what kinds of problems are inherent in a multicentre, interprofessional research project involving a large number of countries. The findings serve as an important knowledge base in a future project. Experiences from the pilot study and the benefits of it are presented.

Family carers. 4: Designing services to support family carers in Sweden

This, the last of four articles focusing on family caregiving in Sweden, considers ways in which services can be designed to better support and complement care provided by the family. Drawing on the results presented in the previous three articles (Vol 8(9): 582-8; Vol 8(10): 647-52; Vol 8(11): 735-40) the need to provide flexible and responsive services will be highlighted. While acknowledging the importance of services which help with the physical aspects of caring, emphasis will be placed on the need to develop an expanded range of interventions which recognize and respond to the social and emotional impact of caring.

Family carers. 1: Difficulties and levels of support in Sweden

Sweden has a well developed welfare system and until fairly recently the needs of family carers have received limited attention. However, there is now a growing acceptance of the need to provide better and more sensitive support services. Using questionnaires validated in the UK and translated into Swedish, this series of four articles considers the difficulties, satisfactions and coping mechanisms of a sample of Swedish carers, identifying the implications of the results for the design and delivery of healthcare interventions. This article focuses on carers' perceived difficulties and their satisfaction with existing levels of help.