Analysis of Participation in Discharge Planning by Visiting Nurse

Abstract

＊3) HAKUJUUJI VISITING NURSE STATION, TOKYO, JAPANPurpose: This study examined differences in circumstances during transition from a hospital to a home-care setting, depending on whether or not visiting nurses were directly involved in discharge coordination by visiting the hospital prior to patient discharge. Subject: The subjects were 12 family members providing care mainly for patients aged 65 years or older who were discharged from acute care hospitals in Tokyo. Methods: The subjects were divided into 2 groups based on the presence or absence of visiting nurses' direct involvement in discharge coordination: an"involvement group" , if patients were discharged after visiting nurses took part in discharge planning in the hospital; or a"no involvement group" , if patients were discharged based on a regular discharge procedure without any involvement of visiting nurses during hospitalization. Data were collected through self-administered questionnaire surveys and semi-structured interviews. The interview results were examined and classified by the researchers. Feelings and experiences of the subjects during transition to a home environment from the hospital were analyzed employing a qualitative and descriptive approach.Results: An analysis of the level of involvement in discharge coordination showed that community cooperation was in place for the "involvement group" , with the greater involvement of hospital staff and collaborative relationships between visiting physicians/ nurses and the hospital, compared with the"no involvement group" . Regarding the introduction of social resources to discharge planning, care plans for the"involvement group" , made prior to patient discharge, incorporated social resources needed for home treatment and recuperation. In contrast, care plans for the"no involvement group" , made prior to discharge, did not include social resources, and the lack of care and competence became evident after home-based care was started. Their initial care plans had to be revised to include nursing and social support services such as long-term care services.Regarding the feelings and experiences of the subjects during discharge coordination and the transition to home care, the "involvement group"was provided not only with home treatment/ recuperation arrangements coordinated by various professionals, but also with support from visiting nurses who adopted a proactive stance in planning and delivering care services. They felt reassured by being able to consult at any time. In contrast, the"no involvement group" realized after discharge that preparation for home-based care was insufficient, and had their care plans rearranged by home-care service providers. They were aware of the lack of support personnel at the time of patient discharge. Conclusion: Social resources were effectively introduced to the"involvement group" through multidisciplinary collaboration, and the presence and responses of visiting nurses contributed to a sense of ease that there was someone to consult with. On the other hand, the"no...