Perth Children's Hospital, Western Australia, Australia; Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
J Pediatr Nurs. 2021 Sep-Oct;60:83-91. doi: 10.1016/j.pedn.2021.02.017. Epub 2021 Mar 3.
To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia.
A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2-4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge.
Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2-19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency.
The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience.
Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information.
观察和描述西澳大利亚州一所三级儿童医院在出院时进行医院到家庭过渡的护士-照顾者之间的沟通情况，描述内容包括有关出院的过渡信息。
采用多阶段定性描述设计，对 31 名患者从医院到家庭的过渡经历进行了 31 次直接临床观察，并在出院后对 20 名照顾者和 12 名护士进行了半结构化访谈。11 名照顾者在出院后 2-4 周时再次接受访谈。对音频记录和现场记录的文字记录进行了内容分析。检查病历以确定患者在出院后 30 天内使用医院服务的情况。
内容分析中出现了四个主题：医院到家庭过渡信息的结构；过渡信息的传递；出院准备情况；出院后的恢复情况。对病历的检查发现，有 7 名患者在出院后 2-19 天内到急诊科就诊，其中 3 人再次入院。3 名再次入院患者的主要照顾者英语水平有限。
该研究证实了将儿科患者从医院过渡到家庭的复杂性。信息内容和传递的不一致影响了照顾者对出院准备情况和恢复情况的感知。
护士需要评估出院准备情况，使用经过验证的工具确定个人需求。应在初级和临时工作人员的入职培训中纳入有关医院到家庭过渡信息和出院计划/流程的教育内容，以确保信息传递的一致性。在整个住院期间，应为语言能力有限的照顾者安排口译服务，特别是在提供过渡信息时。护士应使用回授技巧来提高照顾者对信息的理解程度。
