Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item One Chance to Get it Right: Exploring Perspectives and Experiences in Care Home Discharge Decision-Making in the Acute Hospital(Wiley, 2025-09-05) Stevenson, Gemma; Burton, Jennifer Kirsty; Shenkin, Susan D.; MacArthur, Juliet; McCormack, Brendan; Clare Halpenny; Rhynas, SarahBackground Discharge from acute hospital to new care home is a complex and life changing process often involving several key stakeholders in decision-making such as the older person, their significant person and members of the multidisciplinary team. There is limited research exploring the perspectives of these stakeholders, including factors that influence decision-making and how this is communicated. Objective This study explored how decisions are made to discharge older people directly from hospital to care home, considering the perspectives and experiences of those involved. Methods A case study design was used to explore the experiences of six older people admitted to acute hospital from home for whom discharge to care home was planned. Six datasets were formed, each comprising semi-structured interviews with the person, their significant person(s) (if applicable), multi-disciplinary professionals and review of health and social-work records. Datasets were analysed using an inductive thematic approach before cross-dataset analysis. Results Findings emphasised the complex and personal nature of decision-making. The older person was often keen to talk about their decision. Significant people highlighted the complexity of balancing risk and care needs. However, the magnitude of the decision to older people and their significant persons appeared to go underacknowledged by professionals. The hospital context was significant as a location for decision-making. Communication was integral to the experiences of those involved; however, uncertainty and lack of role clarity impacted this. Conclusions This study offers new insights into the complexity of discharge to care home from hospital. This life-changing decision requires greater recognition by professionals. Improved understanding of the process and well-developed communication is central to enhancing the experience for those involved. Implications for Practice The significance of this oftentimes final decision should not be underestimated. The findings indicate a clear need for interdisciplinary education about care home discharge, and the importance of professionals' availability and approachability throughout decision-making. Professionals are encouraged to recognise a shared responsibility for the provision of information and guidance, and create opportunities for open and supportive conversations with older people and their families to explore the decision and discuss their feelings.Item New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis(Wiley, 2018-03-24) Rhynas, Sarah J.; Garcia Garrido, Azucena; Burton, Jennifer K.; Logan, Gemma; MacArthur, JulietAims and objectives: To gain an in-depth understanding of the decision- making pro-cesses involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records.Background: The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision- making.Method: A purposive sample of 10 cases was selected from a cohort of 100 individu-als admitted to hospital from home and discharged to a care home. Cases were se-lected to highlight important personal, relational and structural factors thought to affect the decision- making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making.Results: Care home discharge decision- making is a complex process involving stake-holders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient’s voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice.Implications for practice: Nurses have a critical role in the involvement of older peo-ple making discharge decisions in hospital, improved documentation of the patient’s voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs.Item Decisions affecting discharge from hospitals directly to care homes(EMAP, 2017-05-31) Harrison, Jennifer Kirsty; MacArthur, Juliet; Garcia Garrido, Azucena; Logan, Gemma; Rhynas, Sarah J.; MacLullich, Alasdair M. J.; Shenkin, SusanAdmission to care homes following acute hospital admission is common, despite being contrary to UK health policy. Care home admission from hospital is also a care trajectory that is under-researched and poorly understood. A retrospective cohort study reviewed the case notes of 100 people who had experienced this transition, what happened during their hospital stay, and what led to the life changing decision to discharge them to a care home. Only 37% of individuals were documented as having been involved in the decision-making process. This article describes the study methods, highlights some salient results, and makes recommendations for practice.Item New institutionalisation following acute hospital admission: A retrospective cohort study(Oxford University Press, 2016-10-15) Harrison, Jennifer Kirsty; Garcia Garrido, Azucena; Rhynas, Sarah J.; Logan, Gemma; MacLullich, Alasdair M. J.; MacArthur, Juliet; Shenkin, SusanBackground: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective: to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting: a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects: 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods: a single researcher extracted data from ward-based case notes. Results: people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital. Conclusions: care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.Item Implementing person‐centred key performance indicators to strengthen leadership in community nursing: A feasibility study(Wiley, 2020-08-13) McCance, Tanya; Dickson, Caroline; Daly, Laura; Boomer, Christine; Brown, Donna; Lynch, Brighide; MacArthur, Juliet; Mountain, Kristina; McCormack, BrendanAims To explore the utility and feasibility of implementing eight person‐centred nursing key performance indicators in supporting community nurses to lead the development of person‐centred practice.