Menzies Health Institute Queensland, Griffith University, Southport, Qld, Australia.
School of Nursing & Midwifery, Griffith University, Southport, Qld, Australia.
J Clin Nurs. 2018 Mar;27(5-6):e712-e725. doi: 10.1111/jocn.14144. Epub 2018 Jan 15.
To identify barriers and facilitators to engagement of people with dementia and family carers in planning for discharge from hospital.
Hospital discharge can be particularly challenging for older people with dementia. To assist in the development of bespoke discharge processes that address the unique needs of older people with dementia, an integrated review of the literature was undertaken.
A four-stage integrative review framework guided the review. Three search strategies were employed: a computerised database search, a hand search of reference lists and forward citation searching. Paired members of the research team reviewed eligible full-text papers. The methodological quality of each paper was assessed using the Mixed-Methods Assessment Tool, followed by data extraction and completion of summary tables. Within and across study analysis and synthesis of study findings was undertaken using thematic synthesis.
Fifteen papers were included in the review. Most identified barriers to collaborative discharge processes related to distributed responsibility for discharge, risk averse approaches to discharge, limited family carer confidence, and limited validation of assumptions about family competency to manage at home. Facilitators included supported clinician and family carer engagement, and maintaining independence for activities of daily living.
Reflective analysis of discharge decisions, focused on risk and possible risk aversion, can assist teams to evaluate the quality of their discharge decisions. The use of formal communication strategies such as a patient/family-held journal of the hospital experience and a structured family meeting early in the hospital admission can enhance family engagement in discharge planning. Prevention of functional and cognitive decline is emerging as critical to improving hospital discharge outcomes.
确定痴呆症患者及其家属参与规划从医院出院的障碍和促进因素。
对于患有痴呆症的老年人来说，出院可能特别具有挑战性。为了协助制定专门针对痴呆症老年人独特需求的出院流程，对文献进行了综合回顾。
采用四阶段综合审查框架指导审查。采用了三种搜索策略：计算机数据库搜索、参考文献列表的手工搜索和前向引文搜索。研究团队的两名配对成员审查了符合条件的全文论文。使用混合方法评估工具评估每篇论文的方法学质量，然后进行数据提取并完成汇总表。通过主题综合，对研究结果进行了研究内和研究间的分析和综合。
共纳入了 15 篇论文。大多数发现的协作出院流程障碍与出院责任分散、对出院风险规避的方法、有限的家庭照顾者信心以及对家庭管理能力的假设缺乏验证有关。促进因素包括支持临床医生和家庭照顾者的参与，以及维持日常生活活动的独立性。
对出院决策进行反思性分析，重点关注风险和可能的风险规避，可以帮助团队评估出院决策的质量。使用正式的沟通策略，如患者/家属持有的医院经历日记和在住院早期举行的结构化家庭会议，可以增强家庭对出院计划的参与。预防功能和认知能力下降正在成为改善医院出院结果的关键。
