No description available.

Background and purpose: The needs for the post-discharge care increases in tandem with the rapid growth of the ageing population. Discharge planning, as part of continuity of care, is parallel with nursing care. The nurses play the key role in the discharge planning process. Their understanding and attitudes towards discharge planning are likely to affect the practice and the effectiveness of discharge planning. Therefore, this study aimed to explore the nurses¡¦ understanding of the discharge planning process and their attitudes towards it. Methods: The self- administrated questionnaires were delivered to all the nurses working in a general care units in the medical center in southern Taiwan. 332 nurses were approached. The data were analyzed by SPSS 12.0 applying descriptive statistics, ANOVA, chi-square test and Pearson correlation analysis. The reliability of the questionnaire is 0.882. Results: The net response rate is 69.9 percent. About 43 percent of the respondents are with the employment length over 10 years. 43 percent of the respondents had received discharge planning education. Only 10.7 percent of respondents got involved in the discharge planning meetings frequently. The mean value of the understanding between the respondents with the discharge planning training and those without were significantly different (p < 0.001). The significant difference was found in the understanding among the respondents with the different level of involvement in the discharge planning meetings (p< 0.001). There was a significant difference found in the mean value of attitudes among the respondents with different frequency of involvement in the discharge planning meetings. The mean scores of the whole attitudes were significantly higher in the respondents with training than in those without training (p=0.014). Understanding was associated with duration of employment, the discharge planning training or education, and level of involvement in the discharge planning meetings. Attitudes were associated with the level of involvement in the discharge planning meetings and workload. The strong correlation was found between the respondents¡¦ understanding and attitudes. Conclusion: Understanding of the discharge planning process and the attitudes towards discharge planning were influenced by the duration of employment, the involvement in the discharge planning meetings and the education or training regarding discharge planning. Therefore, to increase the understanding and to change the attitudes, the nurses should be provided with the more discharge planning education and opportunities to participate in the discharge planning meetings.

The purpose of this study is to evaluate the satisfaction and performance indicators in discharge planning services at a regional hospital in Taiwan. A structured questionnaire incorporating client databases, services items, performance indicators and satisfaction surveys was employed. A self-constructed structural questionnaire, with content validity of 0.7 which was verified by five experts and examined with Cranbach £\, is employed as a key research tool. Data were collected from March 2007 to September 2007. In total, 321 clients accepted discharge planning services and gave their choices among the offered after-discharge caring services. Visit with the phone after coming out of hospital, nine people who is death, eight people who have not contact, total seventeen people was deletes. As a result, a total of 304 respondents or 94.7% response rate, responded their satisfaction levels via telephone interview thereafter. The results show that the respondents suffering from CVA (p<0.05) and head injury (p<0.01) accepted (statistically significantly) more medical transfer services than those with lung diseases; the respondents who were taken care by caring institutions after discharge accepted more nursing teaching services than those live with family members (p<0.01); the respondents living with family members after discharge received more medical transfer services than those staying with caring institutions (p<0.01); satisfaction levels reported higher in respondents living with family members than those with caring institutions (p<0.01); the more nursing teaching, medical transfer and social services are offered, the higher the satisfaction level is achieved (p<0.01); The results could provide the valuable information on the implementation of discharge planning. The study contributes to several significant results such as: (1) The more demand for tubes care, the more days in hospitalization ¡]r¡×0.28, p¡×0.00¡^and the more unexpected emergency care within two weeks¡]r¡×0.14, p¡×0.02¡^. (2) Significant difference ¡]F=5.13, p¡×0.02¡^was found between relocation and total days in hospitalization. Post hoc analysis shows clients who live with family had statistically significant less days in hospitalization than those who were relocated to other hospitals (p=0.008) and caring institutions (p=0.008). (3). Significant difference of satisfaction was found among different relocations¡]F¡×3.50, p¡×0.01¡^. Clients who live with family displayed statistically higher satisfaction than those who were relocated to caring institutions. (4). Significant difference of days in hospitalization was found between on nasal-gastric tube¡]F¡×9.64, p¡×0.000¡^and on tracheal tube¡]F¡×30.13¡Ap¡×0.000¡^ (5). Different departments show significant difference in unexpected emergency care within two weeks¡]F¡×20.12¡Ap¡×0.00¡^. The unexpected emergency care within two weeks in the Medical Department was statistically higher than the Surgical Department. (6). Positive correlations (p<0.05) were found between days in hospitalization and several satisfaction measurements, indicating the more days in hospitalization, the more time available to provide services and the higher client satisfaction can be achieved. Furthermore, clients with unexpected emergency care within three days displayed statistically low satisfaction. The results are capable of providing us information for improvement so as to ensure that clients can receive sustainable, effective and integrated care.

No description available.

The overall aim of this thesis is to describe how elderly women’s encounters with an institutionalised world of health care manifest itself in a discharge planning conference (DPC). The thesis is based on eight video recorded DPCs and follow-up interviews with the women who took part in the conferences. The result of study I, a case study, showed that the woman’s experience of taking part in the DPC was characterised as a feeling of powerlessness. The women’s possibility to have influence on the care planning was small (Study II). Study III revealed that the participants adopted or were assigned to different roles during the DPC. As these roles collided dilemmatic situations occurred. Simultaneously the women and family members struggled to manage the institutional frame that surrounded the meeting by trying to find room within it or by challenging it. Study IV revealed that the women found themselves to be in a vulnerable situation. Their body had failed them, their future was insecure and they felt unprepared as they took part in the DPC. They felt as if they were being affiliated with the other participants in a joint project, as if they were standing outside the event or as if they were in focus for the conversation which. The last was a double edged experience: getting confirmative attention but also being exposed as dependent. Four themes characterise the care that was jointly constructed by all participants during the DPC. These themes are “Care as spirit of community and confirmation”, ”Care as alienation”, ”The incomprehensible care” and “The inflexible and betraitful care”.The result gives rise to questions about the relevance of DPCs in their present shape. Further research and developmental projects requested to achieve dicharge planning conferences that are corresponding better to official caring ideals and the patients needs.

The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that have been shown to be effective in reducing hospital readmissions. the purpose of this study is to review relevant literature related to the problem of hospital readmissions for our elder population. This study is designed to look at interventions, both disease based and non-disease based, that have been previously implemented and have shown effective reductions in readmission rates. This analysis and synthesis can provide an important contribution to our understanding of the factors and variables that influence the readmission rates of our elder population. This review has the potential to assist and direct hospital administrators and to discharge planners, social workers, and other health professions to implement intervention strategies that promote the continuing health status of our elder population while reducing their overall rates of readmissions.

För patienterna är det viktigt att övergången mellan olika vårdgivare sker på ett tryggt och säkert sätt som underlättar den fortsatta vården. Forskning visar att patienternas delaktighet i förberedelser inför utskrivning från sjukhus ofta brister. Sjuksköterskorna på vårdavdelningen upplevde att arbetet inför utskrivning var stressigt.   Syftet med förbättringsarbetet var att identifiera och implementera åtgärder som möjliggör en välfungerande och trygg utskrivningsprocess. Syftet med studien av förbättringsarbetet var att identifiera faktorer av betydelse för implementeringen av förbättringsåtgärder på en vårdavdelning.Metoden för genomförande av förbättringsarbetet följde principerna för förbättringsrampen. Studien av förbättringsarbetet var en fallstudie med explorativ ansats. Data om personalens erfarenheter av förbättringsarbetet inhämtades med intervjuer som analyserades med kvalitativ innehållsanalys.   Resultatet av förbättringsarbetet visade inte någon mätbar förbättring av utskrivningsprocessen. Resultatet av studien visade att vårdpersonalen ändå upplevde förbättringar och att motivation och praktiska förutsättningar för att delta var viktiga för resultatet.   Slutsatsen var att förbättringsarbetet var värdefullt och medförde ett lärande, även om mätbara mål inte uppnåddes. Ledningsens engagemang var viktigt för att skapa möjligheter för personalen att delta i förbättringsarbete. Valet av förbättringsområde hade stor betydelse för resultatet då det påverkade de medverkandes motivation. / "It feels great when you can improve things for the patients" Safe hospital discharge, a case study of an improvement work   An important aspect of health care, from the patient’s perspective, is to achieve smooth and efficient transitions between different health care providers. Current research shows that the patient’s involvement in discharge planning before leaving the hospital is often deficient. Furthermore, nurses at the hospital ward experience discharge planning as stressful work.   The aim of the improvement work was to identify and implement measures for improving discharge process. The method underlying this improvement work is referred to as “the improvement ramp”, and an exploratory case study was carried out. Data was collected, by interviewing health professionals, and analysed using qualitative content analysis.   The results of the implemented measures show no measurable improvements in the discharge process. However, the interviews indicate that health professionals experienced improvements in their daily routines. The conclusion was that the improvement work was valuable and resulted in a developed learning although the measurements didn’t capture all results. The choice of area for improvement was of great importance because it affected the participants' motivation.

Bakgrund Första januari 2018 kom en ny lag om samverkan vid utskrivning från sjukhuset till Primärvård, där Primärvården har huvudansvaret för utskrivningsplaneringen. Då samverkanslagen är ny, var det svårt att finna studier om hur distriktssköterskorna/sjuksköterskorna upplever att vara ansvariga vid utskrivningsplaneringen. Syfte Syftet med studien var att beskriva hur distriktssköterskor/sjuksköterskor upplevde att arbeta med utskrivningsplanering från sjukhus till primärvård och hur de upplevde att vara ansvariga för denna planering utifrån den nya samverkanslagen.  Metod Studien använde en kvalitativ ansats och deskriptiv design. Semistrukturerade intervjuer med elva distriktssköterskor/sjuksköterskor användes som datainsamlingsmetod. Data analyserades med kvalitativ innehållsanalys Huvudresultat Resultatet visade att det som påverkade distriktssköterskorna/sjuksköterskorna mest i arbetet med utskrivningsplanering var bristen på kommunikation och information från sjukhuset. Att få information om patientens tillstånd och behov av insatser efter hemgång, var en stor utmaning. Sökandet efter information var mycket tidskrävande och innefattade flera olika sökvägar. Samtliga distriktssköterskor/sjuksköterskor uppgav att de ofta ringde sjukhuset och anhöriga till patienten för att få information. När sjukhuset hade en vårdplanerare med erfarenhet och kompetens, upplevde deltagarna att information gällande patientens status och planerade åtgärder var tydligare, vilket bidrog till en tryggare hemgång för patienten.   Slutsats Studien har visat att distriktssköterskor/sjuksköterskor i Primärvården tyckte det var svårt att vara ansvariga vid utskrivningsplanering. Problem med att få information från sjukhuset, avsaknad av rätt kompetens hos vårdplaneraren på sjukhuset, utbildning i kommunikationssystemet Lifecare, samt tidsbrist var bekymmersamt. / Abstract Background January first 2018, a new law came into force on discharge from the hospital to primary healthcare, where primary healthcare was responsible for the discharge planning. When the collaboration law is new, there were difficulties finding studies of how the districtnurses/registered nurses find themselves responsible for the discharge planning. Aim The aim of the study was to describe how districtnurses/registered nurses experienced working with discharge planning from hospital to primary healthcare and how they felt responsible for this planning based on the new collaboration law. Method The study used a qualitative approach and descriptive design. Semi-structured interviews with eleven districtnurses/nurses were used as a data collection method. Data was analyzed with qualitative content analysis. Main findings The result showed that what influenced the districtnurses/nurses most in the work on dischargeplanning was the lack of communication and information from the hospital. Getting information about the patient's condition and the need for intervention after the return home was a great challenge. The search for information was very timeconsuming and included several different paths. All districtnurses/nurses stated that they often called the hospital and relatives to the patient for information. When the hospital had a dischargeplanning nurse with experience and expertise, the participants experienced that information regarding the patient's status and planned measures was clearer, which contributed to a safer homecoming for the patient. Conclusion The study has shown that districtnurses/nurses in primary health care felt it was difficult to be responsible for dischargeplanning. Problems with getting information from the hospital, lack of proper competence of the dischargeplanning nurse at the hospital, training in the communication system Lifecare, and time shortage were worrying.

Objectives: Transitions of care (ToC) for a high-risk neonatal population, and in some cases inappropriate and early discharge, can have important implications for community and broader population health. As it is a key indicator of the efficiency of the system of health services, the ease of ToC has been a priority for improving care outcomes across all settings in our nation’s healthcare system. Research shows that inappropriate discharges can lead to negative outcomes for patients and their families, health professionals, and the health system. Collaboration amongst the health care professionals, the community, and the patient’s family is needed for an efficient transition. This research examined how interprofessional collaboration (IPC) can act as a catalyst for efficient and effective ToC from a high-risk neonatal unit to care back in the community. Approach: Twelve infants were observed from their admission on the Neonatal Intensive Care Unit (NICU) until their discharge home. The 12 consisted of four patients discharged directly home, four to another unit within the same hospital, and four to another institution. Stage one involved a document analysis of documents related to ToC policy on the NICU. Stage two involved observation. Stage three involved interviews with healthcare professionals (HCPs) in the hospital and community (n=30) and family members (n=12). Stage four consisted of deliberative workshops with the hospital management and research participants to share the results and obtain their feedback. Results: Including parents early in the ToC planning process helps parents feel they’re a part of the interprofessional care team, in-charge of their infant’s care and thus better equipped mentally to handle their infant’s ToC. Knowing early on their infant’s discharge plan allows parents the opportunity to ask questions regarding caring for the infant at home or to meet the new healthcare team at the new site (hospital/floor) prior to the transfer. Mechanisms need to be in place to ensure that communication regarding ToC is consistent and clear to and between all HCPs whether in the hospital (e.g. bedside nurse) or in the community (e.g. family doctor). Having a clear understanding of what information should be transferred during a ToC will prevent unnecessary tests and misunderstandings. Increasing HCPs’ knowledge of available community resources will aide in transitioning infants to community care and thus freeing bed space and decreasing unnecessary costs at the hospital (i.e. A feeding and growing baby can be weighed by family doctor or Rapid Response Nurse and not necessarily the neonatologist). A consistent ToC policy across all NICUs would also be beneficial to ensuring a smoother ToC of infants. Conclusion: It is believed that communication and education in an interprofessional context is critical for more efficient and effective ToC of neonates.

Low health literacy is a public health crisis, currently, there is limited research on social worker engagement with the low health literate patient. The research questions for this study examined health literacy knowledge in medical social workers and how their MSW curricula built their knowledge of health literacy. It also explored challenges that arise when discharge planning for patients with low health literacy. It also asked what social workers can do to aid patients with limited health literacy during the discharge planning process. This basic qualitative research study used criterion sampling and was informed by the socioecological model. Data collection used 2 focus groups of 12 medical social workers comprised of 11 females and 1 male. Data analysis occurred by categorizing the data then classifying the data into themes based on the research question. Key findings include: (a) social workers have a medium to high level of health literacy; (b) MSW curricula would benefit from health literacy knowledge; and (c) challenges occur in discharge planning with people with low health literacy that include overall knowledge and attitudes of health literacy, sociodemographic variables, and lack of preventative health. Recommendations include standardizing healthcare social worker roles and providing educational opportunities in MSW curricula on health literacy. Implications for social change include improved health outcomes, empowering individuals to take personal responsibility for their healthcare which in the long run can help them overcome chronic disease and other health related anomalies. Social change may be seen with hospital health literacy screening to reduce hospital readmissions decreasing individual healthcare costs and reduce societal healthcare costs.