Preparation For Hospital Discharge Research Articles

Readiness for Hospital Discharge and Its Influencing Factors: A Review

Readiness for hospital discharge is a multidimensional concept involving needs assessment, collaborative patient-centered care, resource management, and care coordination. It begins with admission assessment and treatment planning and then predicts patient readmission and continuity of care. Different studies have revealed moderate readiness for hospital discharge in various patient groups, with a focus on somatic diseases and less on mental disorders. Low readiness for hospital discharge leads to hospital readmissions, as well as financial and psychosocial burdens on patients and their families. As a result, patients, families, healthcare professionals, and community workers must work together to ensure readiness for hospital discharge. Despite the fact that these procedures are currently performed by nurses, nurses’ heavy workloads may have an impact on patients' preparation for hospital discharge. Additionally, various social demographic factors, illness-related variables, and psychological support have an impact on readiness for hospital discharge. Younger age, urban residence, higher level of education, and better financial status are positively correlated with increased readiness for hospital discharge, but disease severity, long duration of hospital stay, and limited continuity of care are negatively correlated with readiness for hospital discharge. In conclusion, readiness for hospital discharge is crucial for safe transitions; thus, addressing its influencing factors through teamwork and patient-centered methods may enhance understanding and meeting the unique needs of patients, particularly those with chronic and mental illnesses, allowing a successful transition from the hospital to the community.

Percepções de pessoas idosas internadas acerca da transição do cuidado do hospital para casa

Abstract Objective To analyze the perceptions of older adults hospitalized regarding the transition of care from hospital to home. Method A qualitative, descriptive-exploratory research was conducted in a clinical inpatient unit of a medium-sized public hospital in the interior of São Paulo state, Brazil. Twenty-two older adults participated in the study through semistructured interviews, guided by questions based on the pillars of the Care Transitions Intervention (CTI). Subsequently, participant observation was conducted at the study site, with recording in a field diary and transcription of speeches. Thematic analysis and data systematization followed through specific software for qualitative data analysis Results The mean age of the participants was 68 years (SD±5.4); 16 (77%) had one or more chronic diseases; 14 (64%) were using one or more continuous medications. The primary International Classification of Diseases code for hospitalization was Covid-19. The average length of hospital stay was 9 days (SD±5.7), with a maximum of 31 days and a minimum of two days, with four (18%) experiencing severe disease. From the perception of older adults, four themes of analysis emerged: medication-related problems; preparation for hospital discharge; continuity of care; and family network. Conclusion From the perspective of older adults, it is necessary to organize the care plan during hospitalization through medication reconciliation, preparation for home care, family presence during hospitalization, and recognition of Primary Health Care in continuity of care during the transition from hospital to home care.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study.

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Mobile Videoconferencing for Occupational Therapists' Assessments of Patients' Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study.

BackgroundOccupational therapists who work in hospitals need to assess patients’ home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients’ home environments could be an innovative solution to allow better and more appropriate recommendations.ObjectiveThe aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients’ home environments.MethodsOccupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients’ homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient’s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews.ResultsEight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not.ConclusionsThe use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning.International Registered Report Identifier (IRRID)RR2-10.2196/11674

Nurse-led care management models for patients with multimorbidity in hospital settings: A scoping review.

The aim of this scoping review is to map the nurse-led care management models for patients with multimorbidity in hospital settings. Patients with multimorbidity in hospital, due their complexity, benefit a nurse-led care management model. This care management model allows for better identification of patients' needs and a person-centred approach. This review followed the JBI methodology for scoping reviews. The search included the international databases Web of Science, CINAHL, MEDLINE, Nursing & Allied Health Collection and grey literature. A total of 21 articles were included in the final content analysis. Three categories of nurse-led care management models emerged from the data, namely, nurse-led programs, case management and nurse facilitator models. The interventions focused on training, discharge support, follow-up, health promotion and patient-centred care. The centrality of the patient is a common characteristic of nurse-led care models, namely, the acquisition of disease self-management skills, preparation for hospital discharge and continuity of care in the community. Nurse-led care management models can empower patients to manage their chronic conditions more effectively. Adapting these care management models in hospital settings will be a challenge for nurse managers. The full protocol used can be accessed at doi:10.11124/jbies-20-00222.

Nurse's performance in the hospital discharge process of children with chronic disease.

To analyze the nurse's performance in the hospital discharge process of children with chronic disease. Qualitative research conducted from May to August/2019 with ten nurses working in a pediatric unit of a public hospital. The data, collected through semi-structured interviews, were submitted to inductive thematic analysis. In the preparation for hospital discharge, nurses recognize health education as their attribution, valuing family knowledge in the training regarding home care. Nevertheless, their practice is weakened by the little articulation among the multiprofessional team, reduced nursing sizing and disarticulation in the health care network. There is a paradox between the report and the practice of the hospital discharge process accomplished by nurses. Although they have theoretical knowledge, their work process is influenced by the disarticulated way in which the multiprofessional team interacts, and the conditions provided by the institution to work in the preparation for hospital discharge of these children.

Evaluation of patient preparation for hospital discharge after gastrectomy

Evaluation of patient preparation for hospital discharge after gastrectomy

TRAINING OF CAREGIVERS OF CHILDREN WITH SPECIAL HEALTHCARE NEEDS: SIMULATION CONTRIBUTIONS

ABSTRACT Objective: to know the contributions of simulation regarding the training of caregivers of children with special healthcare needs, in the preparation for hospital discharge. Method: descriptive-exploratory study, with qualitative approach, carried out with caregivers of children with special healthcare needs. The study was developed in a simulation center of a public university in the South of Brazil, in partnership with a state reference children's hospital. The training program was based on simulations, using low, medium and high fidelity simulators, in which 15 caregivers participated. Data were collected through semi-structured interviews and submitted to content analysis, in its thematic modality. Results: two categories emerged: simulation as a learning strategy and implications of training for home care. The simulations allowed the improvement of procedural skills and coping with possible complications in the home setting. Feelings of fear and anxiety were initially triggered, especially in the high fidelity simulation. However, after the training, the caregivers felt relieved, self-confident and satisfied with their performance, highlighting the importance of the support provided during the simulations. They reported having greater confidence to perform the procedures on the child and face the challenges of home care. Conclusion: the simulation was considered a valid strategy for the training of caregivers, stimulating empowerment and self-confidence in the face of complex care required by a child with special healthcare needs. The study innovates by exploring the potentialities of simulation in this context, bringing important contributions to qualify the home care of this clientele.

Conocimientos de enfermería y su relación con la satisfacción materna de un programa canguro

Antecedentes: el programa madre canguro-PMC es una estrategia de bajo costo que contribuye a reducir la tasa de mortalidad neonatal de los nacidos prematuros hacia 2025.
 Objetivo: determinar la relación entre los conocimientos de enfermeras y la satisfacción de usuarias de un programa madre canguro.
 Material y métodos: estudio correlacional en un Hospital/Maternidad de San Luis Potosí 2015. Participaron 30 Madres-canguro a quienes se aplicó: cuestionario de satisfacción de usuarias Picker’s Pediatric Acute Care (validado en población latinoamericana) y 21 Enfermeras con aplicación de Cuestionario Conocimientos PMC-Corpus (cronbach 0.934).
 Análisis descriptivo y correlacional (r Pearson).
 Resultados: satisfacción global de madres-canguro (87.7%), la mejor calificación (≥90%) fue obtenida en: confort físico, coordinación de cuidados, y accesibilidad del personal. La menor calificación fue en continuidad del cuidado (74.3%) y permanencia y visitas (74.1%). El conocimiento adecuado de enfermeras sobre PMC (57.1%), éste se correlacionó con la satisfacción materna (r=0.532, p≤0.05).
 Conclusión: las madres-canguro mostraron satisfacción con el programa, excepto en continuidad del cuidado. Las áreas de oportunidad se visualizan en la preparación para el alta con inclusión y capacitación de padres/familia, y la capacitación de enfermería en el programa.

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days.

Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient-reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. A two-sample pre- and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process' impact. Health team members (n=105 [pre], n=95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge-related communication and collaboration. Patients (n=413 [pre], n=191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi-square and t tests were used for unadjusted pre- and postintervention comparisons. Logistic regression of readmissions with a matched pre- and postintervention sample included adjustments for patient characteristics and hospitalization factors. Readmissions decreased from 18% to 12% (p<.001); ED visits decreased from 4.4% to 1.5% (p<.001). Changes in health team communication and collaboration and patients' experience of discharge were minimal. The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts.

Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure: A multi-centre efficacy study using the Reitan Catheter Pump (RCP)

BackgroundWorsening heart failure complicated by congestion, hypotension, and renal dysfunction is difficult to manage, increasingly common and predicts a poor outcome. Novel therapies are required to facilitate diuresis and implementation of disease-modifying interventions in preparation for hospital discharge. Accordingly, we investigated the haemodynamic and renal effects of the Reitan Catheter Pump (RCP) percutaneous support device in patients admitted with decompensated heart failure (DHF). MethodsThis was a prospective observational study of 20 patients admitted with DHF, ejection fraction < 30%, and Cardiac index (CI) < 2.1 L/min/m2 in need of inotropic/mechanical support. ResultsPatients underwent RCP support for a mean of 18.3 (±6.3) hours. The RCP increased CI from 1.84 L/min/m2 (±0.27), to 2.41 L/min/m2 (±0.45, p = 0.04), increased urine output (71 mL/h (±65) to 227 ml/h (±179) (p = 0.006) with a concomitant reduction in serum creatinine (188 μmol/L (±87) to 161 μmol/L (±78) (p = 0.0007). There were no clinically significant haemolysis, vascular injury, or thrombo-embolic complications. ConclusionsFor patients admitted with DHF, the RCP improves cardiac index, diuresis and renal function without causing important complications.

ACOMPANHAMENTO DOMICILIAR DO RECÉM-NASCIDO DE RISCO: PREPARAÇÃO MATERNA PARA A PROMOÇÃO DA SAÚDE

The objective was to identify maternal doubts about the care of the newborn (NB) at home and the importance of follow-up consultation using strategies for the preparation of mothers in the promotion of home health. Descriptive, qualitative study in Fortaleza-Ceará-Brazil. A semi-structured interview was carried out containing maternal / child identification data and questions related to the maternal preparation for the hospital discharge of the newborn and the organization of educational workshops for maternal guidance regarding the care and follow-up of the newborn at home. The data were analyzed according to the pertinent reading, organized and presented in tables and speeches extracted from the interviews, with the support of a qualitative analysis software, called webQDA®, being presented in textual discussions. It was verified the need for greater training and sensitization of the nursing team in the maternal preparation for hospital discharge and in the optimization of care and improvement in the quality of life of the preterm newborn.

Vulnerability of caregivers of the elderly with dementia: a cross-sectional descriptive study.

to evaluate the sociodemographic and clinical profile of the caregivers and its relation with the overburden from the care of the elderly with dementia. a cross-sectional descriptive study; the sample was non-probabilistic, developed with caregivers of elderly people with dementia. The field of investigation was the Health Care Center of the Elderly and their Caregivers (CASIC), in the city of Niterói, Rio de Janeiro, Brazil. Data collection took place from February to June 2016, with the following instruments: a sociodemographic questionnaire and Zarit scale. fifty percent of the caregivers presented moderate overburden; 38% presented little overburden; and 12% moderate/severe overburden. It was observed that the median of weekly care hours increases as the overburden increases. Caregivers with moderate to severe overburden, in the majority, do not share care. it is clear that the overburden of care places the caregiver in conditions of biological and psychological vulnerability. avaliar o perfil sociodemográfico e clínico dos cuidadores e sua relação com a sobrecarga proveniente do cuidado ao idoso com demência. estudo descritivo transversal, a amostra foi do tipo não probabilística, desenvolvida com os cuidadores de idosos com demência. O campo de investigação foi o Centro de Atenção à Saúde do Idoso e seus Cuidadores (CASIC), Niterói, Rio de Janeiro, Brasil. A coleta de dados ocorreu de fevereiro a junho de 2016, com os seguintes instrumentos: questionário sociodemográfico e escala de Zarit. 50% dos cuidadores apresentaram sobrecarga moderada, 38% apresentaram pouca sobrecarga e 12%, sobrecarga moderada/severa. Observou-se que a mediana das horas de cuidados semanais aumenta conforme a sobrecarga aumenta. Cuidadores com sobrecarga de moderada a severa, em caráter majoritário, não dividem o cuidado. Dessa forma, fica claro que a sobrecarga do cuidado coloca o cuidador em condições de vulnerabilidade biológica e psicológica.

Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice.

Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.

Apnea of prematurity and caffeine pharmacokinetics: potential impact on hospital discharge.

To determine the half-life of serum caffeine concentrations and its relation to apnea of prematurity (AOP) after caffeine is discontinued in preparation for hospital discharge. Prospective cohort study involving preterm infants with gestational ages ⩽33 weeks at birth. After caffeine was discontinued, serum caffeine concentrations and electronic detection of pathologic apnea, defined a priori, were obtained at 24 and 168 h, respectively. Caffeine levels decreased from 13.3±3.8 to 4.3±2 mg l(-1) (n=50, mean±s.d.) at 24 and 168 h, respectively (P<0.01). The mean caffeine half-life was 87±25 h at 35±1 weeks postmenstrual age. Seven days after discontinuation of caffeine, 64% of the infants had pathologic apnea. Hospital discharge planning for preterm infants with a history of AOP should be carefully considered after discontinuing caffeine. This study showed that caffeine may not reach subtherapeutic levels until around 11-12 days.

Zadovoljstvo bolnikov s kronično obstruktivno pljučno boleznijo z obravnavo koordinatorja odpusta

Uvod: Dobra priprava na odpust zveča kakovost življenja bolnika s kronično obstruktivno pljučno boleznijo in zmanjša število hospitalizacij. Z namenom opredelitve zadovoljstva bolnikov s kronično obstruktivno pljučno boleznijo z obravnavo koordinatorja odpusta je bila izvedena neeksperimentalna kvantitativna raziskava. Metode: Raziskava je potekala anonimno, s pomočjo strukturiranega vprašalnika, poslanega po pošti. Sodelovalo je 107 bolnikov, ki so bili zaradi poslabšanja kronične obstruktivne pljučne bolezni hospitalizirani med 2. novembrom 2009 in 6. decembrom 2011 in bili obravnavani s strani koordinatorja odpusta. Vprašalnik je vrnilo 60 bolnikov. Za statistično obdelavo smo uporabili opisno statistiko, faktorsko analizo, linearnoregresijski model in multiplo linearno regresijo. Rezultati: Z analizo smo ugotovili, da lahko s skupnim vplivom treh faktorjev (komunikacija, samoobvladovanje bolezni in doživljanje bolezni oz. simptomi) pojasnimo 84,02 % variance zadovoljstva bolnikov s koordinatorjem odpusta. Z zadovoljstvom bolnikov s koordinatorja odpusta je najbolj povezana komunikacija, sledi ji doživljanje bolezni oz. simptomi. Diskusija in zaključek: Bolniki so zadovoljni z aktivnostmi koordinatorja odpusta v postopku odpusta iz bolnišnice, kar ugotavljajo tudi drugi avtorji. Raziskava pokaže na smiselnost uvedbe profila koordinatorja odpusta v obravnavo bolnikov s kronično obstruktivno pljučno boleznijo. Spremljanje zadovoljstva bolnikov je smiselno, saj pokaže priložnosti za izboljšave dela z vidika bolnika.

A Nurse Leadership Project to Improve Health Literacy on a Maternal-Infant Unit

To describe how participation in the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy positioned the authors to lead an interdisciplinary team through implementation and evaluation of a change project related to patient education based upon national health literacy standards. The project goal was to improve patient satisfaction with nurse communication and preparation for hospital discharge. Quality improvement. Mother/-baby unit of an academic medical center serving a high percentage of patients of a minority population and underserved clients. The five- step intervention included (a) review of current health literacy standards, (b) formation of an infrastructure for development and evaluation of existing patient education materials, (c) assessment of patient education materials currently in use, (d) assessment of literacy level and learning styles of new mothers, and (e) provision of continuing education to increase knowledge of nurses as patient teachers and of health literacy. Mean scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the domains of patient satisfaction with nurse communication and discharge information were used to measure patient satisfaction with health communication. Patient satisfaction with nurse communication increased from 75.9% to 84.6%. Satisfaction with discharge information increased from 84.6% to 98.6%. The leadership academy successfully positioned the authors to guide an interdisciplinary team through development of a process to meet the education and communication needs of patients and improve their health literacy. As a result, a positive effect was noted on patient satisfaction with health communication.

P0166 Presence of stoma nurse and quality of life of colorectal cancer patients with fecal ostomy in the early postoperative phase

Background The early postoperative phase is a crucial period for maximising the self-efficacy of patients in preparation for hospital discharge. However, there is scarce research on the effects of the presence of the stoma nurse during this phase on the quality of life (QOL) of colorectal cancer patients with fecal ostomy. This study aimed to determine the following: (1) QOL of patients with colorectal cancer with fecal ostomy in the early postoperative phase, (2) patient-related factors associated with QOL, and (3) relationship of the presence of the stoma nurse with QOL following surgery. Methods The study used a cross-sectional, descriptive correlational design. 93 patients with colorectal cancer from two tertiary hospitals who were at least 3 days post-fecal ostomy surgery were included. Patient-related factors and QOL were assessed through face-to-face interview using a patient information sheet and the validated Filipino version of the Stoma-QoL Questionnaire, respectively. Data collection was done from March to August, 2014. Findings Mean QOL score was 55.5 (SD 9.9), indicating a moderate level of quality of life. Sex, presence of comorbidities, and financial status were patient-related factors found to be associated with QOL. Mean duration a patient was seen by a stoma nurse post-surgery was 5 days (SD 3). Participants had higher QOL scores the earlier they were seen by a stoma nurse, regardless of the type of postoperative intervention needed ( p = 0.029). Interpretation The presence of stoma nurses in the early postoperative phase may have a positive effect on the QOL of patients with colorectal cancer. This presents as an opportunity to implement timely interventions that are evidence-based and sensitive to patient-related factors. More research is needed to examine whether the early presence of stoma nurses may have long-term effects on the QOL of patients with colorectal cancer after discharge.

A review of family carers' experiences of hospital discharge for people with dementia, and the rationale for involving service users in health research.

In the UK, service user involvement is an important factor in health policy, and obtaining research funding. It may be helpful in expanding our knowledge in areas where research evidence is poor such as experiences of hospital discharge planning for the family carers of people with dementia.MethodsA rapid review. All study designs published in the English language were eligible for inclusion. Databases included: Medline, Embase, CINAHL, PsycInfo, Cochrane library and Web of Knowledge. A qualitative analysis was undertaken.ResultsFour themes were identified: preparation for hospital discharge – dissatisfaction with being kept informed, discharge arrangements and management of conditions; little time to prepare. Communication between staff and families at discharge – insufficient communication regarding services, not being listened to and being undervalued as a resource could compromise post-discharge care. Support services post discharge – carers need help negotiating, and working with, services with regard to timing, and meeting requirements. Coping post hospital discharge – inadequate understanding about ability to cope, and patient’s impairment, and family conflict over care may lead to unnecessary re-admission to hospital, or long term care. Evidence of specialist dementia models at discharge is described.DiscussionCarers are not always involved in hospital discharge planning as well as they might be. Issues are complex and depend on a number of factors. Poor communication can be overcome and carers can be better supported to cope post discharge as illustrated in the dementia models. The evidence base is weak but the absence of evidence does not indicate an absence of good practice.ConclusionCarers who may feel their world is far removed from the academic world may not ordinarily participate in research studies. Service users, as co-researchers, may be able to improve trust and rapport between research and communities, collect fresh insights and gain deeper and more insightful data from participants.

A Pilot Study of an Illness Management and Recovery Program in Discharged Patients With Schizophrenia

Accumulated evidence supports the effectiveness of equipping chronically ill patients with illness management knowledge and skills. The Illness Management and Recovery (IMR) program developed by the United States government has been widely adopted for persons with mental illness. However, few studies support its effectiveness in patients with schizophrenia. This pilot study developed a culturally adapted and abbreviated version of the IMR for Taiwanese patients with schizophrenia who were ready for discharge from the hospital. Furthermore, we investigated the impact of the program in terms of illness knowledge, drug attitude, insight, and psychopathology. The original IMR was condensed and modified for implementation during participants' preparation for hospital discharge. Using a preexperimental design, pretest and posttest assessments for a single group of 26 participants received the new IMR twice a week for 3 weeks on the four outcome indicators of illness knowledge, drug attitude, insight, and psychopathology. Participants improved in terms of treatment-related illness knowledge, insight, and affective-domain psychopathology (p < .01) after intervention completion. Average participant attendance was 5.45 sessions out of 6 total sessions. The intensive symptom and medication-focused IMR model for soon-to-be-discharged patients with schizophrenia had positive impacts on illness management. In the future, studies using a two-group randomized controlled design and extended follow-up should be conducted to determine the long-term effects of IMR.