Chin-Yen Han RN, BN, MN (Emergency Nursing)
Total Page：16
File Type：pdf, Size：1020Kb
Queensland University of Technology Faculty of Health School of Nursing Emergency Department Nurses’ Experience of Implementing Discharge Planning for Emergency Department Patients in Taiwan: A Phenomenographic Study Chin-Yen Han RN, BN, MN (Emergency Nursing) Submitted for the award of Doctor of Philosophy July 2008 TABLE OF CONTENTS ABSTRACT ................................................................................................... 6 CHAPTER ONE BACKGROUND AND SIGNIFICANCE OF STUDY ................................. 8 1.0 Introduction .......................................................................................... 8 1.1 Discharge Planning in Contemporary Emergency Nursing Practice ... 9 1.1.1 Emergency nurses ― the key to discharge planning .................... 9 1.1.2 Dilemmas for emergency nurses ................................................. 12 1.2 Development of Discharge Planning in Taiwan ................................ 16 1.2.1 Importance of discharge planning in the emergency department in Taiwan .............................................................................................. 16 1.2.2 Historical development of discharge planning in Taiwan .......... 17 1.3 Summary ............................................................................................ 19 1.4 Aim and Objective of the Research ................................................... 20 1.5 Overview of Chapters ........................................................................ 20 CHAPTER TWO LITERATURE REVIEW ............................................................................ 22 2.0 Introduction ........................................................................................ 22 2.1 Definitions of Discharge Planning ..................................................... 22 2.2 Significance of Discharge Planning ................................................... 25 2.2.1 Health care system reform .......................................................... 26 2.2.2 Demographic changes ................................................................. 29 2.2.3 Hospital and community nurses .................................................. 32 2.2.4 Patients and their families .......................................................... 35 2.3 Nurses’ Experiences of Implementing Discharge Planning ............... 41 2.3.1 Nurses understanding of discharge planning ............................. 41 2.3.2 Assessment of patient needs ........................................................ 47 2.3.3 Communication and coordination .............................................. 53 2.4 Summary ............................................................................................ 58 CHAPTER THREE RESEARCH METHODOLOGY: PHENOMENOGRAPHY ..................... 60 3.0 Introduction ........................................................................................ 60 3.1 Phenomenography: An Overview ...................................................... 60 1 3.1.1 Origins of phenomenography ...................................................... 60 3.1.2 Qualitative research .................................................................... 64 3.1.3 A second-order perspective ......................................................... 65 3.1.4 Non-dualist ontology ................................................................... 67 3.1.5 Conceptions ................................................................................. 68 3.1.6 Epistemological assumptions ...................................................... 74 3.1.7 Phenomenographic results .......................................................... 75 3.1.8 Implications for nursing research and this study ........................ 79 3.2 Research Method ................................................................................ 81 3.2.1 Participant selection criteria and participant hospitals ............. 81 3.2.2 Participant recruitment ............................................................... 82 3.2.3 Data collection ............................................................................ 84 3.2.4 Interview/interview questions ..................................................... 84 3.2.5 Interview setting .......................................................................... 89 3.2.6 Drawing ...................................................................................... 89 3.2.7 Data analysis ............................................................................... 90 3.2.8 Quality of the study ..................................................................... 96 3.3 Ethics Statement ............................................................................... 101 3.3.1 Ethics approvals ........................................................................ 101 3.3.2 Consent ...................................................................................... 102 3.3.3 Confidentiality ........................................................................... 102 3.3.4 Risks .......................................................................................... 103 3.4 Summary .......................................................................................... 103 CHAPTER FOUR THE EXPERIENCE OF IMPLEMENTING DISCHARGE PLANNING 105 4.0 Introduction ...................................................................................... 105 4.1 Categories of Description ................................................................. 107 4.1.1 Categories of description one: ED nurses experience implementing discharge planning as ‘getting rid of my patients’ ..... 107 4.1.2 Categories of description two: ED nurses experience implementing discharge planning as completing routines ................ 117 4.1.3 Categories of description three: ED nurses experience implementing discharge planning as being involved in patient education ............................................................................................ 124 2 4.1.4 Category of description four: ED nurses experience implementing discharge planning as professional accountability ..... 146 4.1.5 Categories of description five: ED nurses experience implementing discharge planning as autonomous practice ............... 160 4.1.6 Category of description six: ED nurses experience implementing discharge planning as demonstrating professional nursing care in the ED ...................................................................................................... 170 4.2 The Outcome Space ......................................................................... 180 4.2.1 The referential aspects .............................................................. 182 4.2.2 The structural aspects ............................................................... 187 4.3 Summary .......................................................................................... 189 CHAPTER FIVE DISCUSSION, RECOMMENDATIONS AND CONCLUSIONS ........... 191 5.0 Introduction ...................................................................................... 191 5.1 Review of the Research Findings ..................................................... 191 5.2 Implications of the Research for Contemporary Emergency Nursing ................................................................................................................ 192 5.2.0 Introduction ............................................................................... 192 5.2.1 Level One: no engagement with discharge planning ................ 192 5.2.2 Level Two: engaging with discharge planning ......................... 195 5.2.3 Level Three: engaging with effective discharge planning ........ 200 5.2.4 ED nurses’ commitment to providing discharge services in the ED ...................................................................................................... 209 5.3 Strengths and Limitations of the Study ............................................ 211 5.3.1 Strengths of the research ........................................................... 211 5.3.2 Limitations of the study ............................................................. 212 5.4 Recommendations ............................................................................ 213 5.4.1 Clinical emergency nursing practice ........................................ 214 5.4.2 Nursing administration ............................................................. 215 5.4.3 Nursing education ..................................................................... 216 5.4.4 Healthcare policy ...................................................................... 216 5.4.5 Further nursing research .......................................................... 217 5.5 Conclusion ....................................................................................... 218 REFERENCES ........................................................................................... 220 3 APPENDIX ................................................................................................ 249 Appendix A Ethical approval (Tau-Yuan General Hospital Department of Health) . 250 Appendix B Ethical approval (St. Paul’s Hospital) .................................................... 251 Appendix C Ethical approval (Queensland University of Technology)..................... 252 Appendix D Participation Information Sheet ............................................................. 255 Appendix E Participant Consent Form ......................................................................