User Experience and Care Integration in Transitional Care for Older People From Hospital to Home

Abstract

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.

User experience and care for older people transitioning from hospital to home: Patients’ and carers’ perspectives

“…However, patients and carers could also be active self‐managers as reflected in the themes: seeking information, discussing and negotiating the transitional care plan, and learning to self‐care. These solution‐oriented themes mirror other research findings . Support from carers and health‐care practitioners and self‐management were emphasized in previous studies about the effectiveness of transitional care interventions with good patient satisfaction ratings and reductions in readmission rates .…”

“…This theme suggests that regaining independence is an important continuing care need and goal of recovery and supports and expands on findings from other studies. In a meta‐synthesis review, user experience of transitional care was a social process of negotiation and navigation of independence for older people and carers . Other research has also found that independence is important to older people living in the community both with and without support .…”

“…Instruments and interview guidelines included a demographic questionnaire for patients, and carers/family, and semi‐structured interview guidelines prompting responses regarding care recipients’ experiences of care transitions, what they valued, and what was missing. Instruments and interview guidelines were developed from a previous literature review, systematic review, meta‐synthesis review and qualitative pilot study . In addition, we used recommendations by Bate and Robert to develop the interview guidelines.…”

The role of ‘mediators’ of communication in health professionals' intersectoral collaboration: An ethnographically inspired study

“…The literature proposes that closer collaboration between various health professionals and facilities is needed to deal with such fragmentation. In addition, studies that explored elderly patients’ admission to EMUs often described their admissions as challenging for both patients and health professionals due to the complex needs of these patients (Allen, Hutchinson, Brown, & Livingston, ; Goodwin et al, ; Gruneir, Silver, & Rochon, ). These problems have also been addressed in a Danish context.…”

Discharge of older patients with chronic diseases: What nurses do and what they record. An observational study

“…The transitional care of chronic disease patients between hospital and outpatient setting is recognised as a period of vulnerability for patients (Allen, Hutchinson, Brown, & Livingston, 2016;D'Angelo et al, 2014). Discharge planning promotes safe and timely transfers between levels of care and between care settings, by identifying the patient's individual needs and appropriate posthospital discharge destination (Allen et al, 2016;Rodakowski et al, 2017).…”