Nursing discharge teaching for hospitalized older people: A rapid realist review

• Published in: Journal of advanced nursing Vol. 76; no. 11; pp. 2885 - 2896
• Main Authors: Pellet, Joanie, Weiss, Marianne, Rapin, Joachim, Jaques, Cecile, Mabire, Cedric
• Format: Journal Article
• Language: English
• Published: Oxford Wiley Subscription Services, Inc 01-11-2020
• Subjects: Clinical medicine; Clinical standards; Curricula; Dissemination; Health care; hospitalization; Hospitalized; Learning; literature review; Meaning; Medical education; Nurses; Nursing; nursing care; Older people; patient discharge; patient education; Patient-centered care; Teaching; Teams; Work skills
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14511

Aim
To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.
Design
Rapid realist review guided by Pawson's recommendations and using the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards.
Data Sources
We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998‐2019.
Review Methods
We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.
Results
We included nine studies and a book to contribute to the synthesis. We developed 10 context–mechanisms–outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients’ readiness to engage in the teaching–learning process; nurses’ teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context–mechanisms–outcome configurations.
Conclusion
This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient‐centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the ‘hidden’ mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.
Impact
The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.
摘要
目标
发展、完善并提出一个项目理论,描述出院护理教学的情境、隐藏机制和预后之间的配置。
设计
以波森建议为指导,采用现实主义和元叙事证据合成法进行快速现实主义回顾:不断发展的标准。
数据来源
评审方法 我们遵循了波森推荐的步骤:初步的项目理论制定;文献检索;文档选择和评价;数据提取;分析和合成过程;介绍和传播修订后的项目理论。
结果
我们囊括了九篇研究和一本用于合成的书籍。我们开发了10种“背景‐机制‐预后”配置,这些配置对初步的项目理论做出不断的完善。这些情境、机制和预后之间的配置分为四类:教学内容的相关性;患者参与教学过程的准备程度;护士的教学技能和医疗团队完成出院教学任务的方法。我们还发现,一些相同的背景会产生相似的结果,但通过不同的机制,强调了“背景‐机制‐预后”配置之间的相互依赖性。
结论
这一快速的现实主义回顾产生一个有关于出院教学如何作用于提高以患者为中心的预后的合成解释。所提出的计划理论对临床实践有着直接的启示作用,让护士在准备患者出院时使用“隐藏”机制赋予意义,并可作为护理教育课程的参考。
影响
出院护理教学的基本组成部分、流程机制、背景和影响没有得到一致或清晰的描述、解释或评估。该回顾揭示了患者和护士之间在教学过程中的潜在背景和机制。由此得出的项目理论可以指导临床护士和管理者改进出院教学内容。