“Hospital nurses should have the opportunity to evaluate discharge support and
determine whether it was effective for patients and family members.”
“Establish a system to measure patient outcomes after discharge.”
8.5.3 Discussion on the Interviews and Analysis
Participants were asked to describe their views on the top four barriers that prevented
effective discharge planning: “The difference in the sense of value between hospital
nurses and home-care nurses,” “lack of communication,” “lack of standardized
terminology in creating discharge summaries,” and “the Electronic Hospital Information System reduces hospital nurses’ assessment ability.” Why did these barriers
occur? Participants described four reasons. First, most nurses work in hospitals, and
nursing procedures differ between home-care nurses and hospital nurses. In addition,
hospital teams lacked awareness of both the capability and scope of home-care
nurses and challenges faced in relation to issues such as access to drugs and
community health equipment loans. Second, although medical fees were paid for
the implementation of interprofessional conferences, the time available for such
conferences was limited. In the future, we should consider how to ensure that
effective conferences are held within a limited time. Third, university nursing
education was problematic. Nursing education textbooks describe the importance
of interprofessional collaboration and the adjustment of social resources, but they do
not provide nurses with comprehensive education regarding what to do. Fourth,
standardized terms for connecting hospitals and home-based care are not based on
common values. Nurses rely on standardized nursing packages for Electronic Hospital Information System. Nurses should understand and operate the meaning of
standardized nursing packages for electronic hospital information systems.
Responses from home-based care and hospital administrators were analyzed, and
the consistency between the two groups with respect to “effective communication
between teams” was most prevalent, with strong similarities also observed for
“appropriate care packages” and “interprofessional team working.” Nurses rely on
fine discharge information, such as the kind provided in Electronic Hospital Information System, for discharge summaries.
It is necessary to promote effective communication between home-care nurses
and hospital nurses through the key elements of IDEAL, rather than a summary
using the Tokyo Metropolitan Discharge Support Manual. As hospital and homecare nurses have the provision of patient-centered care in common, it is important to
create opportunities for hospital nurses to participate in home-based care to enhance
their understanding of home-care nurses’ practices. In addition, it is necessary for
hospital nurses to create opportunities to learn about home-care nurses’ values via
home-care nursing experience and communicate through discharge summaries. The
attainment of experience should focus on the perspectives of hospital nurses
concerned with the transfer of care when discharging patients from the hospital to
the community and those of community nurses receiving patients into their care. The
nursing college curriculum does not provide opportunities for hospital nurses to
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determine whether it was effective for patients and family members.”
“Establish a system to measure patient outcomes after discharge.”
8.5.3 Discussion on the Interviews and Analysis
Participants were asked to describe their views on the top four barriers that prevented
effective discharge planning: “The difference in the sense of value between hospital
nurses and home-care nurses,” “lack of communication,” “lack of standardized
terminology in creating discharge summaries,” and “the Electronic Hospital Information System reduces hospital nurses’ assessment ability.” Why did these barriers
occur? Participants described four reasons. First, most nurses work in hospitals, and
nursing procedures differ between home-care nurses and hospital nurses. In addition,
hospital teams lacked awareness of both the capability and scope of home-care
nurses and challenges faced in relation to issues such as access to drugs and
community health equipment loans. Second, although medical fees were paid for
the implementation of interprofessional conferences, the time available for such
conferences was limited. In the future, we should consider how to ensure that
effective conferences are held within a limited time. Third, university nursing
education was problematic. Nursing education textbooks describe the importance
of interprofessional collaboration and the adjustment of social resources, but they do
not provide nurses with comprehensive education regarding what to do. Fourth,
standardized terms for connecting hospitals and home-based care are not based on
common values. Nurses rely on standardized nursing packages for Electronic Hospital Information System. Nurses should understand and operate the meaning of
standardized nursing packages for electronic hospital information systems.
Responses from home-based care and hospital administrators were analyzed, and
the consistency between the two groups with respect to “effective communication
between teams” was most prevalent, with strong similarities also observed for
“appropriate care packages” and “interprofessional team working.” Nurses rely on
fine discharge information, such as the kind provided in Electronic Hospital Information System, for discharge summaries.
It is necessary to promote effective communication between home-care nurses
and hospital nurses through the key elements of IDEAL, rather than a summary
using the Tokyo Metropolitan Discharge Support Manual. As hospital and homecare nurses have the provision of patient-centered care in common, it is important to
create opportunities for hospital nurses to participate in home-based care to enhance
their understanding of home-care nurses’ practices. In addition, it is necessary for
hospital nurses to create opportunities to learn about home-care nurses’ values via
home-care nursing experience and communicate through discharge summaries. The
attainment of experience should focus on the perspectives of hospital nurses
concerned with the transfer of care when discharging patients from the hospital to
the community and those of community nurses receiving patients into their care. The
nursing college curriculum does not provide opportunities for hospital nurses to
170
K. Katsuyama et al.