Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.

IntroductionIntrahospital transitions (IHTs) represent movements of patients during hospitalisation. While transitions are often clinically necessary, such as a transfer from the emergency department to an intensive care unit, transitions may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals. However, carers frequently experience exclusion from care planning during IHTs, potentially decreasing their awareness of patients’ clinical status, postdischarge needs and carer preparation. The purpose of this study was to explore family carers’ perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care.MethodsSequential, explanatory mixed-methods study involving retrospective analysis of hospital inpatients from a parent study (1R01HS026248; PI Wallace) for whom patient and family carer Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. Maximum variation sampling was used to recruit a subsample of carers with diverse backgrounds and experiences for the participation in semistructured interviews to understand their views of how IHTs influenced preparation for discharge.ResultsOf discharged patients from July 2020 to April 2021, a total of 268 had completed the RHDS and 23 completed the semistructured interviews. Most patients experienced 0–2 IHTs and reported high levels of discharge readiness. During quantitative analysis, no association was found between IHTs and patients’ RHDS scores. However, carers’ perceptions of patient discharge readiness were negatively associated with increased IHTs. Moreover, non-spouse carers reported lower RHDS scores than spousal carers. During interviews, carers shared barriers experienced during IHTs and discussed the importance of inclusion during discharge care planning.ConclusionsIHTs often represent disruptive events that may influence carers’ understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning.

Informal caregivers are frequently excluded during hospital discharge planning, potentially impacting their ability to effectively care for older adults at home. Few studies have examined experiences of spousal versus non-spousal caregivers during hospital discharge planning. In a secondary analysis of a mixed-method study, we quantitatively examined how spousal relationships impact caregivers’ (n=266; 51.8% identified as a spouse or partner) scores of patient discharge readiness using the Readiness for Hospital Discharge Scale (RHDS-CG). We then conducted semi-structured interviews with a participant subset (n=23), and analyzed transcribed interviews using content analysis. First, comparing scores on the RHDS-CG, spouses/partners (88.4%) were more likely than non-spouses (75%) to report RHDS scores of 7+ corresponding with moderate to high readiness (X2 (1) = 8.070, p=.005). Among those interviewed, spouses/partners (65.2%) described their role as long-term, and shared strategies they had learned over time regarding how to seek involvement with healthcare professionals (HCPs). In contrast, non-spousal caregivers (34.8%) viewed their role as short term and struggled with how to communicate with HCPs, citing patient privacy rules and patient autonomy as perceived barriers. Overall, spousal caregivers had more experience with the healthcare system and felt better prepared to assume post-discharge care duties. Exploring the experiences of non-spousal caregivers, which make up more than one-third of our sample, is important since caregiving roles shift away from spouses to adult children and others as people age. Further consideration is necessary regarding how to support non-spousal caregivers in navigating the healthcare system.