FROM HOSPITAL TO HOME: PROFESSIONAL PLANS AND PATIENT WORK.
Contributors: University of Wisconsin--Milwaukee.
Published: 1989
Number of pages: 196
Subjects: Health Sciences, Nursing.; Health Sciences, Health Care Management.
Description: This is a study of how staff nurses in the hospital setting planned post-discharge care for elderly patients with a medical diagnosis of congestive heart failure. Discharge planning, as a part of continuity of care, is a key concept in the delivery of health care today. The shift to a prospective payment system for medical care based on diagnosis-related groups (DRGs) has limited the number of patient hospital days, thereby forcing earlier planning for discharge and in some cases, earlier discharge from the hospital as well. Although implementation of discharge planning has historically been problematic, the issues are more difficult to handle today given the age and acuity of many hospitalized patients, and the hectic, accelerated pace in the hospital.

Perspectives taken to study the hospital vary greatly; the approach used in this study was to examine the hospital from the vantage point of 'patient care processes' as suggested by Mauksch (1972; 1973). The patient care process, in this instance, discharge planning, requires many tasks which the primary nurse is responsible for completing, or referring to others in the hospital. The purpose of the study was to analyze the discharge planning process from the vantage point of the nurse who has been designated as the key player. The research questions are: (1) What is the nurse's perception of her ability to formulate and implement an effective and efficient discharge plan? (2) How do the external environment and the hospital organization influence the process? (3) How do patients transfer the plan to their home setting in order to meet post-hospitalization needs? A grounded theory approach using the constant comparison method was employed to assess these questions. Data were collected from both nurses and patients via focused interviews; forty-three interviews were conducted.

Results of this study indicate that although nurses have knowledge of the process of discharge planning, they were unable to operationalize it due to situational influences. There are external forces (DRGs and technology), and organizational considerations (balance of power and division of labor) that appear to have created conditions of uncertainty for the nurse in relation to her ability to formulate and implement an effective and efficient discharge plan. Thus, the major finding of the study was that implementation of an effective and efficient discharge plan and the current organizational structure of the hospital are incompatible. The policy implication from this conclusion indicates a need to reevaluate the Social Security Amendments of 1983, which initiated the prospective payment system.
Notes: Source: Dissertation Abstracts International, Volume: 51-04, Section: B, page: 1745.

Thesis (PH.D.)--THE UNIVERSITY OF WISCONSIN - MILWAUKEE, 1989.

School code: 0263.