Patient and Caregiver Experience of Hospital Discharge from an Acute Medicine Unit via the Discharge Lounge: A Qualitative Case Study

Discharge lounges enable the swift movement of patients imminently awaiting hospital discharge, to free beds without delay. This Qualitative Yin-Style Case Study describes the patient and caregivers experience of transition from an Acute Medicine Unit (AMU) to a discharge lounge and staff perspectives, as organisers of this process. Audiorecorded, interviews and focus groups were undertaken. Data were analysed using Framework Analysis. Lack of patientcenteredness in moving patients to the discharge lounge emerged with three themes: 'moving the problem'; 'being moved' and 'feeling removed'. Patients were transferred at accelerated speed. Communications between staff, patients and carers were abruptly curtailed. Patient transfer from AMU to a discharge lounge is a transitional stage in the acute discharge process and must be adequately communicated.

The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study

BACKGROUND

Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions.

OBJECTIVE

To explore information needs and decisional role-preferences of parents caring for infants with AD.

METHODS

Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts.

RESULTS

Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor.

CONCLUSIONS

Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.

A descriptive study of meaning of illness in chronic renal disease

AIM

To explore the subjective meaning of illness in a sample of renal patients.

BACKGROUND

Patients' illness representations, such as the meaning they attach to illness, may affect their coping and adaptation. Improved understanding in this area may therefore benefit patient care. Meaning of illness has not previously been explored in renal disease.

DESIGN AND METHODS

Cross-sectional survey (n=405) in a single regional renal unit in the North of England. Ethical approval was obtained and patients gave written consent. The instrument used was an eight-item schema, based on the work of Lipowski (1970, Psychiatry in Medicine 1, 91-102). Field notes regarding rationale for choice were recorded concurrently, then content analysed to enable identification of themes. The chi-square test (significance level P < 0.05) was used to analyse differences in selected meaning in older and younger patients; males and females; and patient groups (predialysis, haemodialysis and transplant).

FINDINGS

'Challenge' was selected by most patients (n=253, 62.5%), with similar results in all three patient groups. Slightly more older than younger patients selected 'challenge', although the difference was not statistically significant and older patients more commonly had a fatalistic interpretation of the option. More men selected 'challenge' than women. Those selecting 'challenge' and 'value' appeared to have a more positive outlook than other patients.

CONCLUSIONS

Patients had identifiable meanings for their illness, and these may be associated with their response to renal disease. The schema appeared to be comprehensive, but is in need of further refinement. Consideration of the possible influence of social desirability is necessary.

Patient roles in decision-making

Participation by patients in making decisions about treatment is widely encouraged. However, there is little evidence from patients about their preferences with respect to this. This study used a card-sort approach to explore the actual and preferred participation in making decisions about treatment among a sample of 405 patients with renal disease. The study identified that the majority preferred to adopt a passive role in decision-making. The findings highlight the need for nurses to identify individual patient preferences with respect to participation and to explore why a person may choose to adopt a particular decision-making role.

Evaluating computer assisted learning for renal patients

Healthcare professionals have become increasingly concerned with evaluating the impact of their interventions. Consumerism, quality initiatives and financial constraints have contributed in large measure to this concern. Consequently, the focus of many studies which involve the introduction of new and untried techniques is often on demonstrating their relative usefulness. This study sought to evaluate the usefulness and acceptability of computer assisted learning (CAL) for use in the education of renal patients on continuous ambulatory peritoneal dialysis. However, several problems were encountered which limited or impaired the evaluation process. We describe these problems and use them to illustrate the difficulties inherent in evaluative research.

Nurses' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.

The development and evaluation of computer assisted learning for patients on continuous ambulatory peritoneal dialysis

This article briefly describes the development and evaluation of six computer assisted learning (CAL) packages for use with renal patients on Continuous Ambulatory Peritoneal Dialysis (CAPD). The factors influencing the choice of CAL as the teaching medium are detailed, and some of the difficulties facing nurses involved in patient education highlighted. An outline of the development of program content is given and the methods to be used in the evaluation are briefly explored. Since data collection has only recently commenced, no conclusions can be drawn. However, the authors' anticipation that the study may help to make inroads into exploring the acceptability of CAL to patients and patient educators is expressed.

Rethinking patient education

The aim of this paper is to critically examine and challenge some of the assumptions which underpin the research and non-research based literature on patient education. Doubts are expressed concerning the transferability of theories of adult learning to patient education; and concern is expressed over the imbalance in the literature where emphasis is placed on the psychological benefits of teaching, rather than physical outcomes. In the light of the available evidence which suggests that nurses are not 'good patient teachers' the case is made to support the suggestion that patient education should become the responsibility of specialist nurses. In addition, computer-assisted learning (CAL) is proffered as the solution to a number of the problems facing patient educators. CAL is seen as a means of empowering the patient, rather than the nurse to take control, and this is viewed as a positive move in the direction of self-care. The paper concludes by suggesting that CAL might be used with good effect by patients with particular learning difficulties; for example the blind or partially sighted, and people who are illiterate or have a low reading ability.