Hindrances and Feasibilities that Affect Discharge Planning: Perspectives Before and After the Development and Testing of ICT Solutions

Sammanfattning: Deficits in collaboration and information exchange during patient discharge from the hospital can cause negative consequences for the patient, such as delayed discharge, readmission, inadequate post-discharge care, and reduced quality of life. Information and communication technology (ICT) can contribute to easing and securing information exchange and collaboration at care transitions from one care provider to another. The overall aim of this doctoral thesis was to gain broader knowledge about the discharge planning process by exploring the experiences of the involved personnel both before and after the development and testing of ICT solutions. Studies I, II and III were conducted before the development and testing of ICT solutions. In study I, the experiences and views of registered nurses (RNs) and district nurses (DNs) regarding information exchange during the discharge planning process (DPP) for patients who required primary healthcare after discharge from hospital were probed. Data were collected through a web based questionnaire and were analysed with descriptive statistics, chi-squared test and qualitative text analysis. In study II, the experiences and views of DNs and homecare organisers regarding the DPP were explored. Individual interviews were conducted with nine DNs and five homecare organisers working in homecare. Data were analysed via qualitative content analysis using an inductive approach. In study III, the DPP was evaluated. Qualitative data from studies I and II together with data the development process and 12 interviews with RNs in hospital care were analysed using Normalisation Process Theory. In study IV, RNs’, DNs’ and homecare organisers’ experiences with an agile development process that included ICT testing were explored. An evaluation form was used to collect data on the experiences of RNs and DNs using videoconference technology. Data were analysed with descriptive statistics. Seven focus group interviews were also performed with 11 RNs, nine DNs and four homecare organisers after the development and testing of ICT. Data were analysed using qualitative content analysis. The results showed significant differences in perceived information exchange (I). Hindrances and feasibilities at the organisational, group and individual levels all affected the workflow. Demands, workload, time, collaboration, and engagement together with knowledge and professional confidence were factors that influenced the DPP (II). The results revealed that the previously DPP was not normalised or embedded within daily work before the development project began (III). RNs, DNs and homecare organisers had reached consensus on what the process was about (coherence) and how they evaluated the process (reflexive monitoring) but not on who performed the process (cognitive participation) and how it was performed (collective action). By integrating an agile development process with the results obtained from studies I, II and III, ICT solutions aiming to support the DPP were tested in study IV. Study IV revealed that the time and timing both at the individual, group, and organisational levels and between those levels was essential for the development and adoption of new processes and products among caregivers. Keywords: discharge planning process, collaboration, information exchange, ICT, experiences, nurses, homecare organisers, qualitative content analysis, descriptive statistics