Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

Abstract

Families are rapidly becoming unpaid givers of complex care. Using McKeehan & Coulton's systems model, this critique reviews the evolution of the structure and processes of discharge planning programmes. It explores three common assumptions: discharge planning programmes are cost-effective, allow for enhancement of patients' and families' quality of life, and ensure continuity of care between hospital and community. Funds are saved due to decreased lengths of initial hospital admissions and readmission rates. However, the cost of additional hospital and community resources is rarely considered. Little evidence supports the concept that discharge planning directly affects a patient's health status. Patients and families often do not perceive the same level of benefit from discharge planning as do health professionals. Several issues surrounding research methodologies used in the reviewed studies are identified. Of particular concern is the lack of qualitative research into patients' and families' experiences. The critique concludes with an exploration of ethical issues and challenges arising from increased emphasis on cost-effective discharge planning. These include patients' rights, provision of sufficient human, social and financial resources, improved hospital-community communications, and control over hospital-developed but community-implemented programmes.

Effectiveness of a pilot project of discharge planning in Taiwan

“…Discharge planning typically includes the following strategies: predischarge instruction, referral for continuing care, procurement of medical devices or social resources, coordination of services, and home follow-up (Jackson, 1994;Naylor et al, 1994). Traditionally, predischarge instruction has been utilized as a way to improve patients' and families' self-care knowledge and skills.…”

“…Length of hospital stay, rate of unplanned readmission, rate of nursing home placement, and level of patient satisfaction have been identified as indicators for evaluating the effectiveness of discharge planning (Jackson, 1994;Naylor et al, 1994;Naylor et al, 1999;Parkes & Shepperd, 2001). In addition, the characteristics and preparedness of patients and their family caregivers both determine the needs of discharge planning and affect the outcomes (Anthony & Hudson-Barr, 1998).…”

Model Development for Health Promotion in the Elderly Participating in Communities

“…These activities gave satisfactory results to let the people in the communities help each other which would become strength for the health promotion in the elderly. Also, it created a good relationship between the aged persons and other villagers (Jackson, 1994). The sub-district administrative organization should assist more budget to operate the activities related to the health promotion as well as coordinate with the government organizations, especially the health care centers and the hospitals, to prepare academic information and correct methods for better result in the health promotion.…”

Discharge Planning

“…These include patients' rights; provision of sufficient human, social, and financial resources; improved hospital-community communications; and control over hospital-developed but community-implemented programs 6 .…”