An integrated review of the literature on challenges confronting the acute care staff nurse in discharge planning

Abstract

This integrative review presents and synthesises previous research investigating practices, perceptions and experiences of bedside staff nurses relative to hospital discharge planning. Preparation for hospital discharge should begin at or prior to admission. Forces in the acute care environment, however, often impede comprehensive discharge planning. Evidence-based redesign of discharge planning processes is a priority for nurses and health care leaders. An integrative review. The review was undertaken using eleven search terms to electronically scan CINAHL, Medline, PsycINFO and Dissertations and Theses databases for the period 1990-2009. Hand searching of reference lists and author searches was also conducted. Sixty English language articles were reviewed; 38 of these 60 publications met the study inclusion criteria. Seven themes were identified across the studies. These themes were intra- and interdisciplinary communication; systems and structures; time; role confusion; care continuity; knowledge; and the invisibility of the staff nurse role in discharge planning. Acute care bedside nurses frequently encounter significant barriers while providing discharge-related care. Although these barriers have been identified consistently in numerous studies spanning nearly two decades, few published reports address interventions designed to overcome identified obstacles and inefficiencies. Additional discharge planning redesign initiatives, which include rigorous evaluation of patient outcomes, are needed. As the direct caregivers with the most consistent presence and knowledge of patients' postdischarge needs, acute care bedside staff nurses play a critical role in preparing patients and families for the transition from hospital to home. Nurses are uniquely positioned to identify barriers and opportunities in discharge planning processes and contribute significantly to evidence-based reform initiatives. Effective and efficient patient-centred discharge planning processes can facilitate the transition from hospital to home and begin to address the adverse events experienced by some patients in the immediate postdischarge period.