Patient experiences of in-hospital preparations for follow-up care at home.

AIMS AND OBJECTIVES: To examine patient experiences of hospital-based discharge preparation for referral for follow-up home care services. To identify aspects of discharge preparation that will assist patients with their transition from hospital-based care to home-based follow-up care. BACKGROUND: To improve patients' transitions from hospital-based care to community-based home care, hospitals incorporate home care referral processes into discharge planning. This includes patient preparation for follow-up home care services. While there is evidence to support that such preparation needs to be more patient-centred to be effective, there is little knowledge of patient experiences of preparation that would guide improvements. DESIGN: Qualitative descriptive study. METHODS: The study was carried out at a supra-regional hospital in Eastern Canada. Findings are based on thematic content analysis of 13 semi-structured interviews of patients requiring home care after hospitalisation on a medical or surgical unit. Most interviews were held within one week of discharge. RESULTS: Patient experiences were associated with patient attitudes and levels of engagement in preparation. Attitudes and levels of engagement were seen as related to one another. Those who 'didn't really think about it', had low engagement, while those with the attitude 'guide me', looked for partnership. Those who had an attitude of 'this is what I want', had a very high level of engagement. CONCLUSIONS: Previous experience with home care services influenced patients' level of trust in the health care system, and ultimately shaped their attitudes towards and levels of engagement in preparation. RELEVANCE TO CLINICAL PRACTICE: Patient preparation for follow-up home care can be improved by assessing their knowledge of and previous experiences with home care. Patients recognised as using a proactive approach may be highly vulnerable.

Reasons for returning to the emergency department following discharge from an internal medicine unit: perspectives of patients and the liaison nurse clinician.

AIMS AND OBJECTIVES: To understand the patients' reasons for returning to the emergency department soon after their discharge from an internal medicine unit and to compare these reasons with the liaison nurse clinician's risk assessment tools used for discharge planning. BACKGROUND: Returns to the emergency departments soon after discharge from the hospital are a recurrent problem. Factors precipitating readmission to hospital have been analysed through the lens of health care providers, but few studies have explored the patients' perspectives on their reasons for returning to the emergency departments. DESIGN: A qualitative, descriptive study. METHODS: Semi-structured interviews were conducted with a convenience sample of eight patients recruited from a major teaching hospital in Montreal, Canada. Three different data sources were triangulated: patients' perspectives obtained through interviews and data from the tools used by the liaison nurse clinician, the Bounceback Probability Legend and the LACE Index Scoring Tool. RESULTS: Most patients attributed their return to the emergency department on being discharged too soon, feeling weak at discharge, having limited help at home with managing chronic illnesses and insufficient discharge instructions. participants' reasons for returning differed from those predicted by the liaison nurse clinician's evaluation using the risk assessment tools of each participant's risk of return. CONCLUSIONS: This study highlights patients' frailty upon discharge from the hospital and their informational need on their health condition and their support need to rely on during convalescence at home. Patient's readiness and concerns were not integrated as part of the liaison nurse clinician's evaluation tools for discharge planning. This led to discrepancies between the perspectives of the patients and the liaison nurse clinician about discharge planning. RELEVANCE TO CLINICAL PRACTICE: Health care professionals should evaluate patients' understanding of their illness, their readiness for self-management and work collaboratively with patients to assess concerns before discharge, so that appropriate support can be mobilised to prevent readmission.

A "basket of care" for heart failure patients managing at home: evaluating a community-based nursing intervention from a patient's perspective.

BACKGROUND: Patients with heart failure (HF) in the community represent a large and growing patient population whose complex care requires implementation of innovative care modalities. The Centre Hospitalier--Centre de Sante et de Services Sociaux--Corridor of Service for Heart Failure Patients (CH-CSSS-CSHFP) represents a novel approach to address the challenges of delivering comprehensive care to HF patients in the community. PURPOSE: In this study, the researchers aimed to answer the question: What is the patient's perception of care received in the CH-CSSS-CSHFP? METHOD: A descriptive qualitative design and semistructured interviews guided the inquiry. SAMPLE: A convenience sample (n=5) of HF patients was recruited from five community health centres. RESULTS: Themes that arose from analysis included "Staying home": A shared goal of the patient and service, "Checking on": Health-related monitoring, and "Being connected": Ties to the health care system. CONCLUSION: Results of this study provide insight into the patient's unique perspective on how this service has impacted his/her HF management and may assist health care professionals in designing more effective community-based services.