Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-16T15:30:24.544Z Has data issue: false hasContentIssue false
  • English
  • Français

Mediators of marginalisation in discharge planning with older adults

Published online by Cambridge University Press:  20 June 2016

EVELYNE DUROCHER ,
BARBARA E. GIBSON  and
SUSAN RAPPOLT
EVELYNE DUROCHER*
Affiliation:
School of Occupational Therapy Occupational Science Field, Faculty of Health Sciences, Western University, London, Ontario, Canada.
BARBARA E. GIBSON
Affiliation:
School of Physical Therapy, University of Toronto, Canada. Bloorview Research Institute, Holland Bloorview Kids Rehab Hospital, Toronto, Canada.
SUSAN RAPPOLT
Affiliation:
Department of Occupational Science and Occupational Therapy, University of Toronto, Canada.
*
Address for correspondence: Evelyne Durocher, School of Occupational Therapy Occupational Science Field, Faculty of Health Sciences, Western University, 1201 Western Road, London, ON, N6 G 1H1, Canada E-mail: [email protected] or [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Returning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.

Keywords

discharge planningolder peoplerehabilitationsafetycase studiesdecision makingethnography
Type
Articles
Information
Ageing & Society , Volume 37 , Issue 9 , October 2017 , pp. 1747 - 1769
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramson, J. 1988. Participation of elderly patients in discharge planning: is self-determination a reality? Social Work, 33, 5, 443–8.Google Scholar
American Occupational Therapy Association n.d. Standards of Practice for Occupational Therapy. Available online at https://www.aota.org/-/media/Corporate/Files/Practice/OTAs/ScopeandStandards/Standards%20of%20Practice%20for%20Occupational%20Therapy%20FINAL.pdf [Accessed 10 November 2015].Google Scholar
Atwal, A. 2002. Nurses’ perceptions of discharge planning in acute health care: a case study in one British teaching hospital. Issues and Innovations in Nursing Practice, 39, 5, 450–8.Google Scholar
Brookman, C., Jakob, L., DeCicco, J. and Bender, D. 2011. Client-centred Care in the Canadian Home and Community Sector: A Review of Key Concepts. Saint Elizabeth, Markham, Canada. Available online at http://www.saintelizabeth.com/getmedia/4aba6e8e-0303-4b9c-9117-a8c22a43f8bd/Client-Centred-Care-in-the-Canadian-Home-and-Community-Sector.pdf.aspx [Accessed 10 November 2015].Google Scholar
Brown, D. 1995. Hospital discharge preparation for homeward bound elderly. Clinical Nursing Research, 4, 2, 181–94.Google Scholar
Bull, M. and Kane, R. 1996. Gaps in discharge planning. Journal of Applied Gerontology, 15, 4, 486–500.Google Scholar
Bull, M. and Roberts, J. 2001. Components of a proper hospital discharge for elders. Journal of Advanced Nursing, 35, 4, 571–81.Google Scholar
Butler, N. 1989. Dispelling ageism: the cross-cutting intervention. Annals of the American Academy of Political and Social Science, 503, 1, 138–47.Google Scholar
Butler, N. 2009. Combating ageism. International Psychogeriatrics, 21, 2, 211.Google Scholar
Canadian Institute of Health Information (CIHI) 2012 a. Ontario Trauma Registry 2012 Report: Hospitalizations for Major Injury in Ontario, 2010–2011 Data. Available online at https://secure.cihi.ca/estore/productSeries.htm?pc=PCC44 [Accessed 10 November 2015].Google Scholar
Canadian Institute of Health Information (CIHI) 2012 b. More than 5600 Canadians Seriously Injured Every Year from Winter Activities. Available online at http://www.cihi.ca/CIHI-ext-portal/internet/en/document/types+of+care/specialized+services/trauma+and+injuries/release_17jan12 [Accessed 10 November 2015].Google Scholar
Canadian Physiotherapy Association 2012. Position Statement on Safety. Available online at http://www.physiotherapy.ca/getmedia/a6bbcaf4-a787-44fb-870f-627dfdba236f/Patient-Safety_en.pdf.aspx [Accessed 10 November 2015].Google Scholar
Clemens, E. 1995. Multiple perceptions of discharge planning in one urban hospital. Health and Social Work, 20, 4, 254–61.CrossRefGoogle ScholarPubMed
Connolly, M., Grimshaw, J., Dodd, M., Cawthorne, J., Hulme, T., Everitt, S., Tierney, S. and Deaton, C. 2009. Systems and people under pressure: the discharge process in an acute hospital. Journal of Clinical Nursing, 18, 4, 549–58.Google Scholar
Cott, C. 2004. Client-centred rehabilitation: client perspectives. Disability and Rehabilitation, 26, 24, 1411–22.Google Scholar
Crennan, M. and MacRae, A. 2010. Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical and Occupational Therapy in Geriatrics, 28, 1, 33–43.Google Scholar
Denson, L., Winefield, H. and Beilby, J. 2013. Discharge planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals. Scandinavian Journal of Caring Sciences, 27, 1, 3–12.Google Scholar
Dierckx de Casterle, B., Gastmans, C., Bryon, E. and Denier, Y. 2012. QUAGOL: a guide for qualitative data analysis. International Journal of Nursing Studies, 49, 3, 360–71.CrossRefGoogle ScholarPubMed
Dill, A. 1995. The ethics of discharge planning for older adults: an ethnographic analysis. Social Science Medicine, 41, 9, 1289–99.Google Scholar
Durocher, E. and Gibson, B. E. 2010. Navigating ethical discharge planning: a case study in older adult rehabilitation. Australian Journal of Occupational Therapy, 57, 1, 2–7.Google Scholar
Eakin, J., Robertson, A., Poland, B., Coburn, D. and Edwards, R. 1996. Towards a critical social science perspective on health promotion research. Health Promotion International, 11, 2, 157–65.Google Scholar
Efraimsson, E., Sandman, P., Hydén, L. and Rasmussen, B. 2006. ‘They were talking about me’ – elderly women's experiences of taking part in a discharge-planning conference. Scandinavian Journal of Caring Sciences, 20, 1, 68–78.CrossRefGoogle Scholar
Ells, C., Hunt, M. and Chambers-Evans, J. 2011. Relational autonomy as an essential component of patient-centred care. International Journal of Feminist Approaches to Bioethics, 4, 2, 79–101.CrossRefGoogle Scholar
Foss, C. and Hofoss, D. 2011. Elderly persons’ experiences of participation in hospital discharge process. Patient Education and Counselling, 85, 1, 68–73.Google Scholar
Generations Early Learning and Family Centre 2015. Generations. Available online at http://www.intergenchildcare.com/ [Accessed 10 November 2015].Google Scholar
Gerteis, M., Edgeman-Levitan, S., Daley, J. and Delbanco, T. 1993. Introduction: medicine and health from the patient's perspective. In Gerteis, M., Edgeman-Levitan, S., Daley, J. and Delbanco, K. (eds), Through the Patient's Eyes. Jossey-Bass, San Francisco, 1–18.Google Scholar
Griffith, J., Brosnan, J., Lacey, K., Keeling, S. and Wilkinson, T. 2004. Family meetings – a qualitative exploration of improving care planning with older people and their families. Age and Ageing, 33, 6, 557–81.Google Scholar
Gullette, M. 1997. Declining to Decline. University of Virginia Press, Charlottesville, Virginia.Google Scholar
Harvey, L. 2013. Social Research Glossary. Quality Research International. Available online at http://www.qualityresearchinternational.com/socialresearch/csr.htm [Accessed 10 November 2015].Google Scholar
Hedgecoe, A. 2004. Critical bioethics: beyond the social science critique of applied ethics. Bioethics, 18, 2, 120–43.CrossRefGoogle ScholarPubMed
Hinck, S. 2004. The lived experience of oldest-old rural adults. Qualitative Health Research, 14, 6, 779–91.Google Scholar
Huby, G., Holt Brook, J., Thompson, A. and Tierney, A. 2007. Capturing the concealed: interprofessional practice and older patients’ participation in decision making about discharge after acute hospitalization. Journal of Interprofessional Care, 21, 1, 55–67.Google Scholar
Huby, G., Steward, J., Tierney, A. and Rogers, W. 2004. Planning older people's discharge from acute hospital care: linking risk management and patient participation in decision making. Health, Risk and Society, 6, 2, 115–32.Google Scholar
Kane, R. and Levin, C. 1998. Who's safe? Who's sorry? The duty to protect the safety of clients in home- and community-based care. Generations, 22, 3, 76–81.Google ScholarPubMed
Law, M., Polatajko, H., Baptiste, S. and Townsend, E. 1997. Core concepts of occupational therapy. In Townsend, E. (ed.), Enabling Occupation: An Occupational Therapy Perspective. CAOT Publications ACE, Ottawa, 29–56.Google Scholar
LeClerc, M., Wells, D., Craig, D. and Wilson, J. 2002. Falling short of the mark: tales of life after hospital discharge. Clinical Nursing Research, 11, 3, 242–60.Google Scholar
Mackenzie, C. 2008. Relational autonomy, normative authority and perfectionism. Journal of Social Philosophy, 39, 4, 512–33.CrossRefGoogle Scholar
Mackenzie, C. and Stoljar, N. 2000. Introduction: autonomy refigured. In Mackenzie, C. and Stoljar, N. (eds), Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford University Press, New York, 3–34.Google Scholar
Merriam, S. 1998. Case Study Research in Education: A Qualitative Approach. Jossey-Bass, San Francisco.Google Scholar
Moats, G. and Doble, S. 2006. Discharge planning with older adults: toward a negotiated model of decision making. Canadian Journal of Occupational Therapy, 73, 5, 303–11.CrossRefGoogle Scholar
National Steering Committee on Patient Safety 2002. Building a safer system: a national integrated system for improving patient safety in Canadian health care. The Royal College of Physicians and Surgeons of Canada. Ottawa, Ontario.Google Scholar
Nay, R. 2002. The dignity of risk. Australian Nursing Journal, 9, 9, 33.Google Scholar
Nelson, T. 2005. Ageism: prejudice against our feared future self. Journal of Social Issues, 61, 2, 207–21.Google Scholar
Ontario 1996. Ontario Health Care Consent Act S.O. 1996, c. 2, Sch. A. Available online at https://www.ontario.ca/laws/statute/96h02 [Accessed 12 February 2016].Google Scholar
Opie, A. 1998. ‘Nobody's asked me for my view’: users’ empowerment by multidisciplinary health teams. Qualitative Health Research, 8, 2, 188–206.Google Scholar
Parsons, C. 2008. The dignity of risk: challenges in moving on. Australian Nursing Journal, 15, 9, 28.Google Scholar
Pearson, P., Procter, S., Wilcockson, J. and Allgar, V. 2004. The process of hospital discharge for medical patients: a model. Journal of Advanced Nursing, 46, 5, 496–505.Google Scholar
Pethybridge, J. 2004. How team working influences discharge planning from hospital: a study of four multi-disciplinary teams in an acute hospital in England. Journal of Interprofessional Care, 18, 1, 29–41.Google Scholar
Providence Health and Services 2015. Childcare: The Intergenerational Learning Centre. Available online at http://washington.providence.org/senior-care/mount-st-vincent/services/child-care/ [Accessed 10 November 2015].Google Scholar
Sherwin, S. 1998. A relational approach to autonomy in health care. In Sherwin, W. (ed.), The Politics of Women's Health: Exploring Agency and Autonomy. Temple University Press, Philadelphia, 19–47.Google Scholar
Sherwin, S. and Winsby, M. 2010. A relational perspective on autonomy for older adults residing in nursing homes. Health Expectations, 14, 2, 182–90.Google Scholar
Swidler, R., Seastrum, T. and Shelton, W. 2007. Difficult hospital inpatient discharge decisions: ethical, legal and clinical practice issues. American Journal of Bioethics, 7, 3, 23–8.CrossRefGoogle ScholarPubMed
Swinkels, A. and Mitchell, T. 2008. Delayed transfer from hospital to community settings: the older person's perspective. Health and Social Care in the Community, 17, 1, 45–53.Google Scholar
Twigg, J. 2006. The Body in Health and Social Care. Palgrave Macmillan, New York.CrossRefGoogle Scholar
Twine, R. 2010. Broadening the feminism in feminist bioethics. In Scully, J., Baldwin-Ragaven, L. and Fitzpatrick, P. (eds), Feminist Bioethics. At the Centre, on the Margins. Johns Hopkins University Press, Baltimore, Maryland, 45–59.Google Scholar
United Kingdom Royal College of Nursing n.d. Patient Safety and Human Factors. Available online at http://www.rcn.org.uk/development/practice/patient_safety [Accessed 10 November 2015].Google Scholar
Wells, D. 1997. A critical ethnography of the process of discharge decision making for elderly patients. Canadian Journal on Aging, 16, 4, 682–99.Google Scholar
Willis, J. 2007. Foundations of Qualitative Research: Interpretive and Critical Approaches. Sage, Thousand Oaks, California.Google Scholar
World Health Organization (WHO) 2009. The Conceptual Framework for the International Classification for Patient Safety: Final Technical Report (Vers. 1.1). Available online at http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf [Accessed 10 November 2015].Google Scholar
World Health Organization (WHO) 2014. Falls Prevention in Older Adults. Available online at http://www.who.int/ageing/projects/falls_prevention_older_age/en/ [Accessed 10 November 2015].Google Scholar
Yin, R. 2003. Case Study Research: Design and Methods. Third edition, Sage, Thousand Oaks, California.Google Scholar