Mf. Jackson, DISCHARGE PLANNING - ISSUES AND CHALLENGES FOR GERONTOLOGICAL NURSING- A CRITIQUE OF THE LITERATURE, Journal of advanced nursing, 19(3), 1994, pp. 492-502
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.