Establishment And Feasibility Study Of Nurse-led Discharge Planning For Older Patients With Dementia

Objectives:(1)To establish a nurse-led discharge planning for older dementia patients;(2)To analyze the feasibility of clinical application of discharge planning established in this study,and discuss the obstacles and promoting factors.Methods:(1)Based on the literature review and theoretical analysis,search evidence of guidelines,expert consensus,systematic review and original articles from database,government websites and association website.Constructed the framework of discharge planning for older patients with dementia initially.(2)Qualitative interview method was applied to revise the discharge planning,and one-to-one semi-structured interviews with 9 medical staffs and 10 caregivers of dementia patients conducted to preliminary construct a nurse-led discharge planning for older patients with dementia.(3)Delphi method was conducted by 2 rounds of 18 experts,the revised nurse-led discharge planning for older patients with dementia was formed.(4)With the method of convenience sampling,22 pairs of older patients with dementia and their caregivers from the department of neurology/geriatrics of 2 grade III comprehensive grade A hospitals in Changsha city of Hunan province were enrolled in a pre-test.After the implementation,calculated patients’ unplanned readmission rate,incidence of adverse events,the medication adherence rate,the compliance of reexamination,and caregivers’ follow-up compliance,satisfaction of the program,and the rate of program completion.Conducted a qualitative interview with stakeholders for participation experience.Results:(1)Based on literature review and theoretical analysis,28 best evidences on the discharge planning for dementia patients were summarized.The program was initially constructed,including 5 first-level indicators,15 second-level indicators,and 74 third-level indicators.(2)Through qualitative interview,four themes and 16 sub-themes were extracted: the discharge services experience of stakeholders,the obstacles to implement discharge planning,the promotion factors of implementing discharge planning and the suggestion of discharge planning.(3)After two rounds of Delphi method,the nurse-led discharge planning for older dementia patients included 5 first-level indicators,19second-level indicators,and 62 third-level indicators.The recovery rates of the two rounds of Delphi method were 78.26% and 100%.The rate of expert suggestion was 94.44% and 55.55%.The average authority coefficient of experts was 0.89,indicating high authority degree of experts.The coefficient of variation of expert opinions ranged from 0.00 to 0.29.(4)The results of feasibility analysis,the compliance of three followup after discharge was 100%,86.36% and 90.91%,the rate of unplanned readmission was 22.73%,the incidence of adverse events was 9.09%,the compliance of reexamination was 59.09%,the medication adherence rate was 95.45%,the satisfaction of the program was 100%,and the rate of program completion was 100%.After implementation,16 stakeholders(8medical staffs and 8 caregivers)involved in discharge planning were interviewed and extracted 3 key themes,participation experiences,factors influencing program implementation,and recommendations for program improvement.Conclusions:(1)The nurse-led discharge planning for older patients with dementia is scientific and feasible in theory and practice.(2)The nurse-led discharge planning for older patients with dementia can facilitate a smooth transition from the inside to the outside of the hospital.