Brief admission for patients with emotional instability and self‐harm: A qualitative analysis of patients’ experiences during crisis

Previous studies report that individuals diagnosed with borderline personality disorder have been met by negative attitudes from healthcare professionals and their care needs have often been neglected during hospitalizations. When symptoms of emotional instability are combined with self‐harm, the resulting crisis often becomes difficult to handle for patients and healthcare professionals. To meet their care needs during these crises, an intervention called ‘brief admission’ (BA) has been developed. The purpose of BA is to provide a timeout, in situations of increased stress and threat, in order to foster self‐management in a safe environment. In the present study, we explored the following research questions: What are patients’ experiences with BA? What do patients consider to be the key components of BA? What improvements are considered relevant by patients? A qualitative design was employed, and 15 patients (13 females, 2 males; mean age 38.5 ± 12.9, range 20–67 years) were interviewed using a semi‐structured interview guide. Thematic analyses were performed, which yielded four themes related to the patients’ experiences: ‘a timeout when life is tough’, ‘it is comforting to know that help exists’, ‘encouraged to take personal responsibility’, and ‘it is helpful to see the problems from a different perspective’. Four themes also described the key components: ‘a clear treatment plan’, ‘a smooth admission procedure’, ‘a friendly and welcoming approach from the staff’, and ‘daily conversations’. Lastly, three themes described areas for improvements: ‘feeling guilty about seeking BA’, ‘room occupancy issues’, and ‘differences in staff’s competence’. Collectively, the findings indicate that BA constructively supports patients with emotional instability and self‐harm during a period of crisis.     

General surgical patients' perspectives of the adequacy and appropriateness of discharge planning to facilitate health decision-making at home

Aim. To investigate general surgical patients’ perspectives of the adequacy and appropriateness of their discharge planning. Objectives. To identify any aspects of discharge planning that could be strengthened to assist people in managing their posthospital care and maintaining continuity of care. Background. Appropriate discharge planning is a priority in today's healthcare environment in which patients are discharged ‘quicker and sicker’, sometimes without home support. Adequate and appropriate discharge planning helps promote health literacy, which has benefits for both patients and their caregivers in helping them manage postsurgical recovery at home. Design. A qualitative, interpretive study was designed in which patients were interviewed at least one week after they returned home from hospital. Methods. Purposeful sampling was used to interview 13 general surgical patients from one of three hospitals (two public and one private) in New South Wales and Queensland, Australia. Data were collected in unstructured interviews and analysed using thematic analysis. Reflective analysis by individual research team members generated preliminary themes, which were then analysed collectively by all members of the research team to achieve consensus on patients’ perspectives. Results. Themes included a ‘one‐size‐fits‐all’ approach to providing discharge information; inconsistent or variable advice from different health professionals; a lack of predischarge assessment of their home and/or work conditions and the need for follow‐up assessment of patient and carer needs. Conclusions. The findings of this study illuminate the need for a more individualized approach to discharge planning, taking into account the patient's age, gender, surgical procedure and family and community support for immediate and longer‐term nursing follow‐up. Relevance to clinical practice. Patients would be more adequately prepared for their recovery period at home, by encouraging client‐centred, interdisciplinary communication between health practitioners; adopting a flexible, approach to discharge planning which is tailored to individual needs of postsurgical patients, particularly in relation to advice and information related to recovery; and encouraging and supporting adequate health literacy for self‐management.     

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected,disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care.     

Consumer-orientated outcomes in discharge planning: a pilot study

? The desired outcome of health care provision can only be known by evaluating care from the perspective of the consumer. ? An exploratory study was undertaken to develop and evaluate a research instrument (a semistructured telephone interview guide) as a measure of patient outcomes in discharge planning. ? A sample of 29 patients was recruited from three medical wards of a large tertiary referral teaching hospital in Sydney, Australia. ? Participants were contacted at home after discharge from hospital and interviewed by telephone. Their perceptions of hospital discharge and continuing care needs were investigated. ? Preliminary analysis of the data obtained in the pilot study demonstrated that there were deficiencies in hospital discharge procedures which impacted on continuing care and that patients can contribute useful information for evaluating and improving discharge planning.     

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.     

Discharge planning in mental healthcare settings: A review and concept analysis

To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty‐nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient‐centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.     

The patient's vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workers

Aim. The aim of the study was to obtain a deeper understanding of the experiences of the discharge process among different professionals. Background. An optimal discharge process for hospitalized elderly to other forms of care is of crucial importance, especially since health and medical policies encourages shorter hospital stays and increased healthcare service in outpatient care. Methods. Nurses and social workers from inpatient care, outpatient care, municipal care and social services were interviewed. Eight focus‐group interviews with a total of 31 persons were conducted. The subsequent analyses followed a phenomenological approach. Results. The findings revealed three themes, Framework, Basic Values and Patient Resources, which influenced the professionals’ actions in the discharge process. The overall emerging structure comprised the patient's vulnerability, dependence and exposed situation in the discharge process. Conclusion. In conclusion some factors are of special importance for the co‐operation and the actions of professionals involved in the discharge process. Firstly, a distinct and common framework, with conscious and organizationally based values. Secondly the need to take the patient resources into consideration. Together these factors could contribute to secure the patients involvement in the discharge process and to design an optimal, safe and good care. Relevance to clinical practice: Collaborative approaches among a range of professionals within a variety of organizations are common, especially in the care of the elderly. The role and support of both the organizations and the educational units are decisive factors in this area.     

Understanding cardiac follow-up services--a qualitative study of patients, healthcare professionals, and managers.

The study explores the experience and understanding of stakeholders involved in follow-up services after a cardiovascular event. A multimethod approach was used consisting of questionnaires, telephone surveys, and in-depth, face-to-face interviews. Five themes were identified: patients wished to be seen in their total context, patients should do as told; healthcare professionals perform check-ups and control cardiac risk factors; healthcare professionals are in charge of the care processes; and the structure and processes of the healthcare organization. Results indicate that healthcare professionals have considerable difficulty in understanding the patient's situation and to collaborate between different levels of care. Furthermore, the total healthcare organization lacked comprehensive and practical structures in the follow-up process, rehabilitation, and secondary preventive services.     

Living with cardiac resynchronization therapy: Challenges for people with heart failure

The number of people with heart failure requiring implantation of a cardiac resynchronization device is increasing in Iran. Although this intervention is an effective life‐saving treatment, several challenges are associated with patients’ lifestyle after insertion. This study identified the challenges and coping mechanisms of Iranians with heart failure living with cardiac resynchronization therapy. A qualitative approach using conventional content analysis was adopted. Seventeen people with heart failure and three nurses were recruited between December 2014 and November 2015 from a teaching hospital and a private clinic in Rasht, Iran. Participants were interviewed using semi‐structured interviews lasting 30–60 min. Five themes emerged: (i) fear of implantation, (ii) the panic of receiving a shock from the device, (iii) lack of control over life, (iv) inadequacies of the healthcare system, and (v) psychosocial coping. A heightened understanding of these challenges and coping strategies could prepare healthcare professionals to provide better routine care, education, and support to the recipients of cardiac resynchronization therapy prior to implantation, during the recovery period, and for long‐term management.     

What are the needs of frail older patients in the emergency department? A qualitative study

BackgroundThere is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission.MethodA qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed.ResultsThe analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences.ConclusionFrail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.     

Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective

Background : Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre‐transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. Objectives : To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre‐transfusion checking behaviours. Measures : A cross‐sectional design was employed assessing willingness to participate in pre‐transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1–7. Participants : One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Results : Mean scores for patients' willingness to participate in safety‐relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4·96–6·27 to 4·53–6·66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Conclusion : Overall, both patients and healthcare professionals view patient involvement in transfusion‐related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.