Nursing discharge teaching for hospitalized older people: A rapid realist review.

AIM

To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.

DESIGN

Rapid realist review guided by Pawson's recommendations and using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards.

DATA SOURCES

We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998-2019.

REVIEW METHODS

We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.

RESULTS

We included nine studies and a book to contribute to the synthesis. We developed 10 context-mechanisms-outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients' readiness to engage in the teaching-learning process; nurses' teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context-mechanisms-outcome configurations.

CONCLUSION

This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient-centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the 'hidden' mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.

IMPACT

The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.