Acute Care Nurses’ Attitudes, Behaviours and Perceived Barriers towards Discharge Risk Screening and Discharge Planning

Abstract

Background: Patient safety and economic imperatives have made discharge planning for patients in acute care increasingly important in the last two decades. Indeed patients have more complex health care needs, shorter lengths of stay and longer recovery times. Discharge planning therefore must start early in the patient’s admission to ensure there is enough time to manage each patient’s discharge appropriately. Nurses have a pivotal role in discharge planning and early assessment for discharge. However, few studies have measured nurses’ compliance with elements of discharge planning or their attitudes towards discharge planning. Aim: The aim of this research was to identify nurses’ discharge planning behaviours, in particular compliance with discharge risk screening (DRS) policy, their attitudes towards discharge planning and the factors influencing their behaviours. Methods: A cross sectional descriptive design was used comprising two components, the first of which was an audit of one hundred patients’ medical records for DRS compliance. The second component was a self-report survey, which was in part informed by the audit results, of 94% of nurses who worked in the setting. Results: Nurses’ compliance with DRS, as observed in the audit and self-report survey, was low (between 24.2% and 33%). Patients admitted with a medical diagnosis (OR = .1 95% Confidence Interval .03 - .37) or surgical diagnosis (OR = .13 95% CI .03 - .06) were significantly less likely to have their DRS completed than patients with a respiratory diagnosis and there was a trend for patients admitted on weekdays to be less likely to have DRS completed (OR = .31, 95% I .08 – 1.2). Nurses had an overall positive attitude to the DRS and discharge planning and their screening was mostly accurate. Furthermore, nurses who complied with DRS policy had a more positive attitude (mean 37.14, SD 3.6) than those who did not (mean 34.77, SD 4.2) (P = .03) and were more likely to start discharge planning early. Nurses identified that the major barriers to DRS and discharge planning were the busyness of the ward on weekdays and patient characteristics. These factors hindered compliance with the DRS policy and discharge planning. Other findings suggest that nurses’ discharge planning knowledge and behaviours were inconsistent, that they were uncertain of their role, and the relationship between medical officers and nurses may have influenced their behaviours. Conclusion: This study determined that nurses do not often comply with DRS policy and therefore starting discharge planning early is hampered. The study suggests that there is a link between nurses’ attitudes, DRS compliance and starting discharge planning early. The implications for nurses’ practice include the need to develop clear guidelines, criteria or processes for discharge planning, which incorporate agreed upon roles for all members of the multidisciplinary team, in particular the nurses’ role. There is also a need to investigate a systematic, methodical approach to discharge planning that includes early screening, using the DRS and involvement of nurses in the development of guidelines and implementation of the systematic approach. Further investigation of nurses’ attitudes toward the DRS and discharge planning is recommended, as this was the only nurse characteristic in this study that was found to be linked to their behaviours.