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You SB. Ethical considerations in evaluating discharge readiness from the intensive care unit. Nurs Ethics 2024; 31:896-906. [PMID: 37950598 PMCID: PMC11370158 DOI: 10.1177/09697330231212338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients' readiness can conflict with perceptions of what readiness means for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families.
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Affiliation(s)
- Sang Bin You
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Xian Yi H, Shuang L, Jie Y, Yan L, Yu L, Li C. Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey. J Clin Nurs 2024. [PMID: 38356194 DOI: 10.1111/jocn.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIMS AND OBJECTIVES To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness. BACKGROUND In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited. DESIGN Cross-sectional study. METHODS Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study. RESULTS Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect. CONCLUSION Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness. RELEVANCE TO CLINICAL PRACTICE It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.
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Affiliation(s)
- Huang- Xian Yi
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Shuang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Jie
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Yan
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Li Yu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Chen Li
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
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Gledhill K, Bucknall TK, Lannin NA, Hanna L. The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals. J Clin Nurs 2023; 32:7519-7529. [PMID: 37403644 DOI: 10.1111/jocn.16820] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
AIM To explore discharge planning with a range of key stakeholders in subacute care, including consumers. DESIGN Qualitative descriptive study. METHODS Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically. RESULTS The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education. CONCLUSION Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge. IMPACT This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. REPORTING METHOD COREQ guidelines were followed in reporting this study. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the design, data analysis or preparation of the manuscript.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- School of Primary and Allied Healthcare, Monash University, Geelong, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Nursing, Alfred Health, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Natasha A Lannin
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Nursing, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute of Health Transformation, Deakin University, Geelong, Victoria, Australia
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Wu DL, Luo CL, Du X, Li PP, Jiang M, Liu T, Sun Y. Current Status and Influencing Factors of Readiness for Discharge of Elderly Patients with Chronic Obstructive Pulmonary Disease. Patient Prefer Adherence 2023; 17:1323-1333. [PMID: 37255947 PMCID: PMC10226539 DOI: 10.2147/ppa.s410725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Readiness for hospital discharge is an important indicator of patients' transition from illness to health and can predict rehabilitation and prognosis. Identifying factors that influence readiness for discharge is crucial for developing effective nursing interventions. Therefore, this study aims to investigate the current status of discharge readiness and its influencing factors in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 311 elderly inpatients diagnosed with COPD were enrolled in this investigation at a tertiary hospital in Chengdu between December 2021 and June 2022. Questionnaires were designed to collect general information, disease-related information, and responses to the Readiness for Hospital Discharge Scale (RHDS) and the Quality of Discharge Teaching Scale (QDTS). Univariate and multivariate linear regression analyses were employed to further analyze factors related to discharge readiness and the correlation between discharge readiness and the quality of discharge guidance. Results The total score of discharge readiness of elderly COPD patients was 77.72 ± 11.86 with a mean score of 6.48 ± 0.19 for each item. The quality of discharge instructions was 110.54 ± 15.66, with a mean score of 6.12 ± 0.15 for each item. Discharge preparation was positively correlated with the quality of discharge guidance. Multivariate analysis showed that marital status, admission mode, length of stay in hospital, Classification of Severity of Airflow Limitation, mMRC classification, number of medications taken with discharge, presence of inhalers in medication orders, mode of home oxygen therapy, and quality of discharge guidance were independent factors of discharge readiness in elderly COPD patients (P < 0.05). Conclusion Both discharge readiness and the quality of discharge guidance for elderly COPD patients in China are currently suboptimal and need further improvement. The survey findings provide valuable insights that can guide future management practices and interventions aimed at improving discharge readiness.
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Affiliation(s)
- Dao-Lin Wu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Chun-Li Luo
- School of Nursing, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xu Du
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Pei-Pei Li
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Min Jiang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Tao Liu
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Department of Oncology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Key Clinical Specialty of Sichuan, Chengdu, Sichuan, People’s Republic of China
| | - Yun Sun
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
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Gledhill K, Bucknall TK, Lannin NA, Hanna L. Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives. BMC Health Serv Res 2023; 23:425. [PMID: 37131178 PMCID: PMC10153031 DOI: 10.1186/s12913-023-09285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. METHODS A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. RESULTS Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). CONCLUSIONS These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Geelong, Australia.
- School of Primary and Allied Healthcare, Monash University, Frankston, Australia.
- Department of Occupational Therapy, School of Primary Health and Allied Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia.
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute of Health Transformation, Deakin University, Geelong, Australia
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Chen Y, Chen Y, Qin T, Fu G, Bai J. Associations of readiness for hospital discharge with symptoms and non-routine utilization of post-discharge services among cancer patients receiving oral chemotherapy at home: A prospective study. J Oncol Pharm Pract 2022:10781552221100720. [PMID: 35548956 DOI: 10.1177/10781552221100720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Readiness for hospital discharge is associated with patients' health outcomes after they return home. However, little is known about this association among cancer patients receiving oral chemotherapy at home. This study aimed to examine whether patients' reported readiness for hospital discharge was associated with symptoms and non-routine utilization of post-discharge services among cancer patients receiving oral chemotherapy at home. METHODS A prospective study was conducted, and 151 cancer patients receiving oral chemotherapy were recruited from a provincial level hospital in South China between October 2018 and December 2019. The primary outcome was readiness for hospital discharge assessed by the Readiness for Hospital Discharge Scale-Short Form on the day of discharge. The secondary endpoints were symptoms assessed by MD Anderson Symptom Inventory and non-routine utilization of post-discharge services within one cycle of chemotherapy at home (21 days). RESULTS Among these 151 participants, 74.2% of them reported as ready for discharge. Patients who were employed, lived in suburban area or villages, had a higher Eastern Cooperative Oncology Group score, took Tegafur as oral chemotherapy, and took oral chemotherapy for the first time reported lower readiness for hospital discharge. These five factors explained 28.1% of variance in readiness for hospital discharge. Patients who were not ready for discharge were prone to report higher symptom severity (p = 0.038). No differences in non-routine utilization of post-discharge services were found between the readiness versus non-readiness for discharge groups (p = 0.891). CONCLUSIONS Most cancer patients receiving oral chemotherapy at home were ready for discharge, which was influenced by employment status, residence status, Eastern Cooperative Oncology Group score, type of oral chemotherapy drug, and the experience of taking oral chemotherapy at home. Patients with lower readiness reported worse symptom severity at home. Routine assessment was suggested to recognize unready patients, and more extensive preparations for discharge were recommended to help them manage symptoms at home.
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Affiliation(s)
- Yongfeng Chen
- Nursing Department, Guangxi Academy of Medical Sciences, 477292The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yanrong Chen
- Department of Chemotherapy, Guangxi Academy of Medical Sciences, 477292The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ting Qin
- Department of Chemotherapy, Guangxi Academy of Medical Sciences, 477292The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guifen Fu
- Nursing Department, Guangxi Academy of Medical Sciences, 477292The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinbing Bai
- 15792Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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