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Using qualitative research in systematic reviews: older people's views of hospital discharge
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, FISHER Mike, et al
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2006
- Pagination:
- 68p.
- Place of publication:
- London
Systematic reviews are usually restricted to quantitative studies. This report demonstrates how the review process can be extended to a synthesis of qualitative studies using the example of older people’s views on hospital discharge. There were two kinds of evidence about the potential effectiveness of discharge arrangements – the review by Parker showing that support could be successfully provided to older people discharged from hospital, and international evidence from Sweden, where a similar reform had been implemented. Closer examination of this evidence provided some of the key reasons why this qualitative synthesis of older people’s views of hospital discharge was undertaken.
Post‐discharge medicines management: the experiences, perceptions and roles of older people and their family carers
- Authors:
- TOMLINSON Justine, et al
- Journal article citation:
- Health Expectations, 23(6), 2020, pp.1603-1613. Online only
- Publisher:
- Wiley
Background: Multiple changes are made to older patients’ medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post‐discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. Aim: To explore the experiences of older patients and their family carers as they enacted post‐discharge medicines management. Design: Semi‐structured interviews took place in participants’ homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Setting and participants: Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty‐seven participants aged 75 plus who lived with long‐term conditions and polypharmacy, and nine family carers, were interviewed. Findings: Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health‐care professionals about medicines changes often lacked detail, which disrupted some participants’ knowledge and medicines management capabilities. Participants used multiple strategies to support post‐discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Discussion and conclusion: Participants experienced gaps in their post‐discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines‐related care during the hospital‐to‐home transition. (Edited publisher abstract)
How older people cope with frailty within the context of transition care in Australia: implications for improving service delivery
- Authors:
- WALKER Ruth, JOHNS Julie, HALLIDAY Dianne
- Journal article citation:
- Health and Social Care in the Community, 23(2), 2015, pp.216-224.
- Publisher:
- Wiley
Transition care is increasingly common for older people, yet little is known about the subjective experience of the transition care ‘journey’ from the perspective of clients themselves. This study examines how older people cope with frailty within the context of a dedicated transition care programme and discusses implications for improving service delivery. Qualitative in-depth interviews were carried out during 2011 in the homes of 20 older people who had recently been discharged from a transition care programme operating in Adelaide, South Australia (average age 80 years, 65% female). Thematic analysis identified three key themes: ‘a new definition of recovery’, ‘complexities of control’ and ‘the disempowering system’. Despite describing many positive aspects of the programme, including meeting personal milestones and a renewed sense of independence, participants recognised that they were unlikely to regain their previous level of functioning. For some, this was exacerbated by lacking control over the transition care process while adapting to their new level of frailty. Overall, this research highlighted that benefits associated with transition care can be undermined by fragmentation in service delivery, loss of control and uncertainties around future support. (Publisher abstract)
Medical patients' experiences of inreach occupational therapy: continuity between hospital and home
- Authors:
- BROWN Sarah, CRADDOCK Deborah, GREENYER Corinne Hutt
- Journal article citation:
- British Journal of Occupational Therapy, 75(7), July 2012, pp.330-336.
- Publisher:
- Sage
Patients moving from hospital to the community can be at risk of experiencing poorly coordinated care, despite the current NHS emphasis on a whole system approach. Inreach services are community based and the same member of staff provides intervention in hospital and after discharge. This qualitative study examined medical patients' experiences of inreach occupational therapy. Semi-structured interviews were conducted with a convenience sample of seven older people living in southern England, following their discharge from a medical inreach occupational therapy service (four women, average age 81 years). Thematic analysis was used to explore findings. There was uncertainty about the role of occupational therapy and concern that participants did not feel involved in their hospital discharge. However the inreach occupational therapy service and its staffing continuity increased some patients’ confidence and provided reassurance during the discharge period and their return home; for other participants accurate information sharing between staff was particularly important at discharge. The authors conclude that all participants valued a seamless service between occupational therapy in hospital and at home. They suggest that patients’ needs could be better met by flexible referral points across the hospital and community interface.
Promoting physical activity in the management of depression. The perspective of older people
- Authors:
- WRIGHT Alan, CATTAN Mima
- Journal article citation:
- Mental Health and Learning Disabilities Research and Practice, 6(1), April 2009, pp.53-67.
- Publisher:
- South West Yorkshire Mental Health NHS Trust and University of Huddersfield
While exercise has been widely proposed in the management of depression in older people, the subjective experiences of individuals participating in this intervention have been neglected. Similarly, little is known about the manner in which unsupervised physical activity is adopted by older people as they recover from an episode of depression. This qualitative study sought the views of 11 older people who had recently been admitted to hospital with depression and attended regular in-patient exercise groups. It was found that participants valued opportunities to exercise when in hospital and reported a range of benefits. Following discharge unsupervised physical activity played a crucial part in the recovery process and three typologies were defined which categorised participants’ motivation to be physically active. It was concluded that opportunities for older people to join exercise groups when hospitalised with depression are likely to be valued and that individual factors should be acknowledged when promoting post discharge physical activity.
Leaving hospital: elderly people and their discharge to community care
- Authors:
- NEILL June, WILLIAMS Jenny
- Publisher:
- HMSO/National Institute for Social Work
- Publication year:
- 1992
- Pagination:
- 179p.,tables,bibliog.
- Place of publication:
- London
Describes the experiences of a small group of people aged 75 years and over, during the time of their discharge from hospital and their first few weeks at home. Contains views and suggestions from the elderly people themselves, their carers and from the home help organisers and home helps who were in touch with them. The study underlines some of the communication problems between hospital and community care services. Implications for policy and practice are outlined.
Safely home: what happens when people leave hospital and care settings?
- Author:
- HEALTHWATCH ENGLAND
- Publisher:
- Healthwatch England
- Publication year:
- 2015
- Pagination:
- 59
- Place of publication:
- London
Presents the findings from an inquiry into the emotional and physical impact of hospital discharge. With the help of 101 local Healthwatch, the enquiry panel heard from over 3,000 people who shared their stories about their experiences of the discharge process, focusing in particular on older people, homeless people, and people with mental health conditions. The findings reveal that there are five core reasons people feel their departure is not handled properly: people are experiencing delays and a lack of co-ordination between different services; they are feeling left without the services and support they need after discharge; they feel stigmatised and discriminated against and that they are not treated with appropriate respect because of their conditions and circumstances; they feel they are not involved in decisions about their care or given the information they need; and they feel that their full range of needs is not considered. The report includes examples of good practice and initiatives and projects designed to help older people, homeless people, and people with mental health conditions resolve the difficulties they experience during the discharge process. (Edited publisher abstract)
Older adults' experiences of occupational therapy predischarge home visits: a systematic thematic synthesis of qualitative research
- Authors:
- ATWAL Anita, et al
- Journal article citation:
- British Journal of Occupational Therapy, 75(3), March 2012, pp.118-127.
- Publisher:
- Sage
The authors believe that, despite predischarge home visits by occupational therapists being common in practice, there has been a tendency to neglect users' perceptions and experiences when evaluating whether this intervention is clinically and cost effective. A qualitative literature review was undertaken as a basis for systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits. Electronic database search were searched, conference proceedings hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America contacted. Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria. Two main themes emerged: older adults' perceptions of home visits, and acceptance of occupational therapy. Although, in general, older adults are satisfied with predischarge home visits, the experience may provoke anxiety for some patients. Older people felt that they were not always involved in the decision making process during the visit, which may result in no-acceptance of the occupational therapy recommendations. The authors conclude that insufficient attention has been paid to older adults' perceptions of predischarge home visits. They believe that further work is necessary to determine their effectiveness from a user’s perspective.
Delayed transfer from hospital to community settings: the older person's perspective
- Authors:
- SWINKELS Annette, MITCHELL Theresa
- Journal article citation:
- Health and Social Care in the Community, 17(1), February 2009, pp.45-53.
- Publisher:
- Wiley
Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients' perspectives. This study sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants' perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over and with a mean delay of 32 days were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. The findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs.
For the sake of their health: older service users' requirements for social care to facilitate access to social networks following hospital discharge
- Authors:
- McLEOD Eileen, et al
- Journal article citation:
- British Journal of Social Work, 38(1), January 2008, pp.73-90.
- Publisher:
- Oxford University Press
Facilitating older service users’ requirements for access to or re-engagement in social networks following hospital discharge is recognized in social care analysis and policy as critically important. This is because of the associated benefits for restoring physical health and psychological well-being. However, it tends to be a neglected dimension of current social care/intermediate care. This paper draws on a qualitative study of voluntary sector hospital aftercare social rehabilitation projects in five UK localities, which focused on addressing this issue. Through examining older service users’ feedback and experience, the study confirms the health benefits of social care facilitating access to social networks at this crucial juncture. By providing sensitive interpersonal interaction, advocacy and ‘educational’ assistance, social care workers supported older service users’ re-engagement in a variety of networks. These included friendship, recreational and family groups, health care treatment programmes and locality based contacts and organizations. As a result, material, interpersonal and health care resources were accessed, which contributed to restoring and sustaining physical health and psychological well-being. The process of such social care also emerged as critical. This included ensuring that objectives reflected service users’ priorities; integrating ‘low-level’ home care; offering befriending; and challenging the pre-set time frame of intermediate care.