1. Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.
- Author
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Noyes, Jane, Brenner, Maria, Fox, Patricia, and Guerin, Ashleigh
- Subjects
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DISCHARGE planning , *HOSPITAL care of children , *CHRONIC diseases in children , *CINAHL database , *CLINICAL medicine , *HOME care services , *HOME nursing , *HOSPITALS , *MEDICAL information storage & retrieval systems , *PSYCHOLOGY information storage & retrieval systems , *MEDICAL care , *MEDICAL personnel , *MEDICAL protocols , *MEDLINE , *NURSES , *NURSING practice , *ONLINE information services , *PARENTS , *PATIENT safety , *PEDIATRICS , *QUALITY assurance , *RESEARCH funding , *ASSISTIVE technology , *SYSTEMS theory , *SYSTEMATIC reviews , *EVIDENCE-based medicine , *DISEASE management , *ACCESSIBLE design , *THEORY , *PROFESSIONAL practice , *OCCUPATIONAL roles , *THEMATIC analysis , *ORGANIZATIONAL governance , *PATIENTS' families - Abstract
Aim To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Background Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Design Novel mixed-method integrative review informed by health systems theory. Data sources CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. Review methods Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Results Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. Conclusion The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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