Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards

TY - JOUR

T1 - Preparing safe discharge in a complex practice

T2 - A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards

AU - Gregersen, Nanna Vendelboe

AU - Refsgaard, Birgit

AU - Sørensen, Dorthe

PY - 2024/9

Y1 - 2024/9

N2 - Introduction: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. Aim: To explore the process of preparing discharge for patients with COPD in a hospital setting. Method: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. Results: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. Conclusion: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.

AB - Introduction: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. Aim: To explore the process of preparing discharge for patients with COPD in a hospital setting. Method: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. Results: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. Conclusion: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.

KW - biopsychosocial

KW - COPD

KW - grounded theory

KW - hospital discharge

KW - nurse

KW - respiratory care

KW - social interaction

UR - http://www.scopus.com/inward/record.url?scp=85190969006&partnerID=8YFLogxK

U2 - 10.1111/scs.13262

DO - 10.1111/scs.13262

M3 - Journal article

C2 - 38622922

AN - SCOPUS:85190969006

SN - 0283-9318

VL - 38

SP - 756

EP - 766

JO - Scandinavian Journal of Caring Sciences

JF - Scandinavian Journal of Caring Sciences

IS - 3

ER -