College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia.
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Nursing and School of Medicine, Baltimore, MD, USA.
J Clin Nurs. 2018 Apr;27(7-8):e1327-e1343. doi: 10.1111/jocn.14261.
To undertake a mixed methods thematic literature review that explored how elderly adults approached decision-making in regard to their health care following discharge.
A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults' management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re-admission.
A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network.
PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty-five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub-themes.
Four main themes associated with health-related decision-making in the elderly were identified: "the importance of maintaining independence," "decision making style," "management of conditions at home" and "discharge planning."
Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended.
Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between patients and healthcare professionals involved in their care.
进行一项混合方法主题文献综述，探讨老年人在出院后如何就其医疗保健做出决策。
在与护理人员进行出院计划时，是做出适当健康决策的关键时期。然而，对于 89%居住在家庭中的老年人如何做出他们的医疗保健决策，我们知之甚少。研究老年人对慢性疾病的管理，作为鼓励症状监测、预防漏诊和发现病情恶化的重要步骤出现。所有这些都应该降低再次住院的风险。
进行了一项混合方法主题文献综述。该结构遵循 PRISMA 报告指南，该指南由 EQUATOR 网络推荐，用于系统评价。
使用关键词、纳入和排除标准，在 PubMed、Cumulative Index to Nursing and Allied Health Literature (CINAHL) 和 Scopus 在线数据库中进行搜索。还考虑了从相关出版物中提取的参考文献，这些参考文献是由专家确定的，并于 1995 年至 2017 年期间发表。对 25 项定性、定量和混合方法研究和综述进行了批判性评估（2013 年 CASP），然后将其纳入综述。使用 Braun 和 Clarke（2006）的步骤分析每个研究的结果，以确定主要主题和子主题。
确定了与老年人健康相关决策相关的四个主要主题：“保持独立的重要性”、“决策风格”、“在家中管理病情”和“出院计划”。
老年人的医疗保健决策偏好被认为非常复杂，并受到多种因素的影响。已经建议开发一种评估这些因素的工具。
护士在探索和理解保持独立性对每个患者的影响方面发挥着至关重要的作用。这种理解为开发一种工具提供了初步步骤，以协助参与患者护理的患者和医疗保健专业人员之间的合作。
