Sarah J. Rhynas

New institutionalisation following acute hospital admission: a retrospective cohort study

Abstract Background institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods a single researcher extracted data from ward-based case notes. Results people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital. Conclusions care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.

New care home admission following hospitalisation: how do older people, families and professionals make decisions about discharge destination? A case-study narrative analysis

AIMS AND OBJECTIVES To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. BACKGROUND The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. METHOD A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. RESULTS Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patients voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. IMPLICATIONS FOR PRACTICE Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patients voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs.

What is the meaning of filial piety for people with dementia and their family caregivers in China under the current social transitions? An interpretative phenomenological analysis

The filial piety model of family centred care has dominated Chinese society for thousands of years. The ways in which filial piety is presented are being modified and modernised as China undergoes social transitions. The study aims to understand the meaning of filial piety for people with dementia and family caregivers. Semi-structured interviews with people with dementia (n = 10) and family caregivers (n = 14) were conducted. Data were analysed using interpretative phenomenological analysis. Three themes emerged: (a) ‘Being filial is a cultural continuity and my future investment’. (b) ‘The changed perception and ways of being filial’. (c) ‘Filial responsibility is a social and cultural convention, but not my personal choice’. This study highlights the importance of cultural values in family care decision making and in shaping filial responsibilities. It indicates that filial obligation can be maintained through social support, even though the nature of filial piety has been changed by social transitions.

Place and recovery from alcohol dependence: A journey through photovoice

ABSTRACT It has been suggested that place, and interaction with the environment, may play a role in recovery from alcohol dependence. In this paper we report findings from a project that used an adapted photovoice methodology to better understand individuals’ experience and perceptions of the role of place in recovery from alcohol dependence. Individuals attending a recovery café in central Scotland documented their environment and, in focus group settings, the individuals discussed and analysed their photographs. Here we report aspects of the environment, both therapeutic and risky, experienced by individuals negotiating the journey of dependence recovery. Elements of the natural environment were largely referred to as supportive and therapeutic, as were other more quotidian spaces, such as the home and café. The largest place‐based risk faced by participants was the persistent availability and marketing of alcohol. The results demonstrate that the journey of recovery from alcohol dependence is contextually shaped, with place both supporting and hindering this journey. HighlightsThis paper enriches our knowledge of the everyday environments of those in recovery.The results demonstrate that recovery from alcohol dependence is contextually shaped.The therapeutic environment includes more quotidian space, beyond the natural.The abundance of alcohol in the environment is a challenge for those in recovery.Photovoice allowed participants to engage with others as experts of their own recovery.

Access to healthcare services for people recovering from alcohol excess

Background People recovering from alcohol excess can struggle to access healthcare services. Understandings of recovery need to be clarified in order to ensure services meet the needs of socially marginalised service users. In Scotland, alcohol excess is estimated to cost £3.6bn annually (Scottish Government 2015) [1]. Ensuring that service users can access appropriate services is a national priority.