Nurse-Caregiver Communication of Hospital-To-Home Transition Information at a Tertiary Pediatric Hospital in Western Australia: A Multi-Stage Qualitative Descriptive Study

Abstract

Purpose: To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia. Design and methods: A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2-4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge. Results: Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2-19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency. Conclusion:The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience. Practice implications: Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information.

Essential elements nurses have to address to promote a safe discharge in paediatrics: A systematic review and narrative synthesis

“…All included studies ( n = 15) were published in English between 2016 and 2022. 12 studies were conducted in the USA (Auger et al., 2018 ; Brooks et al., 2022 ; Desai et al., 2016 ; Jubic et al., 2022 ; Leyenaar et al., 2017 ; Mallory et al., 2017 ; Moo‐Young et al., 2019 ; Parikh et al., 2018 , 2021 ; Patra et al., 2020 ; Shermont et al., 2016 ; Wu et al., 2016 ), one was conducted in Turkey (Ekim & Ocakci, 2016 ), and two in Australia (Aydon et al., 2018 ; Zhou et al., 2021 ).…”

“…Of the included studies, two were randomized controlled trials (Auger et al., 2018 ; Parikh et al., 2021 ), five of them were qualitative studies (Aydon et al., 2018 ; Desai et al., 2016 ; Leyenaar et al., 2017 ; Parikh et al., 2018 ; Zhou et al., 2021 ), six were cohort studies (Brooks et al., 2022 ; Jubic et al., 2022 ; Mallory et al., 2017 ; Moo‐Young et al., 2019 ; Patra et al., 2020 ; Shermont et al., 2016 ; Wu et al., 2016 ), and only one was a case–control study (Ekim & Ocakci, 2016 ).…”

Risk factors associated with 31-day unplanned hospital readmission in newborns: a systematic review

“…Six consistently cited predictors include 4 maternal factors (primiparous, mother being Asian, vaginal delivery, maternal complications) and 2 neonatal factors (male infant and neonatal comorbidities). There is a need to promote healthcare providers’ awareness of risk factors then develop and implement comprehensive individualized hospital-to-home transition plans from the time of admission for the birth through to discharge home to reduce unplanned neonatal readmissions [ 64 ]. Transition checklists and discharge readiness assessments are recommended as strategies to reduce newborn UHRs as the quality of hospital-to-home transition of care is positively associated with the caregiver’s perception of readiness for discharge [ 65 ].…”

Audiovisual Recording in the Inpatient Setting: A Method for Studying Parent–Nurse Communication

“…However, there is great potential in audiovisual data to document and explain patient and family care experiences beyond simply observing participants, particularly in qualitative studies such as those employing focus groups (to differentiate between speakers) and ethnography (to capture situational or environmental elements) (Martínez-Guiu et al, 2022; Sarabia-Cobo et al, 2020). This form of data is especially useful as it can capture both verbal and nonverbal communication and contextual factors essential for understanding family nursing practice such as assessment of caregiver comprehension through observation, demonstration of skills, nonverbal affirmations and reassurances, and eye contact (Giambra et al, 2018; Grant & Luxford, 2009; Zhou et al, 2021). The recordings can also be examined an infinite number of times rather than relying solely on real-time observation that is subject to the bias of the researcher capturing the data (Haidet et al, 2009).…”

“…contact (Giambra et al, 2018;Grant & Luxford, 2009;Zhou et al, 2021). The recordings can also be examined an infinite number of times rather than relying solely on real-time observation that is subject to the bias of the researcher capturing the data (Haidet et al, 2009).…”