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Nurs Inq. 2018 Jul;25(3):e12236. doi: 10.1111/nin.12236. Epub 2018 Apr 1.

Bedside nurses' roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?

Author information

1
Faculty of Medicine, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada.
2
School of Nursing, Dalhousie University, Halifax, NS, Canada.
3
Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
4
Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
5
Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
6
Department of Psychiatry, Faculty of Medicine, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
7
Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK.

Abstract

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.

KEYWORDS:

acute care; discharge planning; ethnography; interprofessional care; interprofessional collaboration; nursing

PMID:
29607602
DOI:
10.1111/nin.12236

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