DISCHARGE PLANNING - ISSUES AND CHALLENGES FOR GERONTOLOGICAL NURSING- A CRITIQUE OF THE LITERATURE

Families are rapidly becoming unpaid givers of complex care. Using McK eehan & Coulton's systems model, this critique reviews the evolution o f the structure and processes of discharge planning programmes. It exp lores three common assumptions: discharge planning programmes are cost -effective, allow for enhancement of patients' and families' quality o f life, and ensure continuity of care between hospital and community. Funds are saved due to decreased lengths of initial hospital admission s and readmission rates. However, the cost of additional hospital and community resources is rarely considered. Little evidence supports the concept that discharge planning directly affects a patient's health s tatus. Patients and families often do not perceive the same level of b enefit from discharge planning as do health professionals. Several iss ues surrounding research methodologies used in the reviewed studies ar e identified. Of particular concern is the lack of qualitative researc h into patients' and families' experiences. The critique concludes wit h an exploration of ethical issues and challenges arising from increas ed emphasis on cost-effective discharge planning. These include patien ts' rights, provision of sufficient human, social and financial resour ces, improved hospital-community communications, and control over hosp ital-developed but community-implemented programmes.