Nursing

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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, Sarah
Background 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.
Understanding the hospital discharge planning process for medical patients with dementia
(Informa UK Limited, 2023-10-21) Duah-Owusu White, Mary; Kelly, Fiona; Vassallo, Michael; Nyman, Samuel R.
Background: Poor hospital discharge processes can result in the readmission of patients and potentially increase the stress levels of carers. Therefore, this study sought to understand the factors related to the discharge planning process for patients with dementia. Methods: The researchers interviewed 32 carers of patients with dementia and 20 hospital staff who worked on medical wards in a United Kingdom (UK) hospital. The semi-structured interviews were analysed thematically using a systems theory (patient–carer–staff relationships, hospital equipment and policies). Results: The findings indicated that the following factors could either have a positive or negative impact on discharge planning: patient (e.g. cognitive capacity), carer (e.g. preconceived ideas about care homes), staff (e.g. communication skills), policy (e.g. procedures such as discharge meetings), equipment (e.g. type of service provider delivering the equipment) and the wider social context (e.g. availability of specialist dementia beds in care homes). Conclusion: It is important for hospital staff to adopt a systems perspective and to integrate the different elements of the hospital system when planning for patients’ discharge.

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