Year

2004

Degree Name

Master of Science (Hons)

Department

Department of Nursing - Faculty of Health & Behavioural Sciences

Abstract

This study investigated perceptions of the discharge planning process by mental health professionals in a regional inpatient mental health service. The burden of mental illness in Australia is growing, with a corresponding increase in demand for services. Continuity of care and effective discharge planning for people with serious and enduring mental illness is considered a complex and multifaceted process. The aims of this study were to identify actual and ideal stakeholder involvement in the discharge planning process; timing and commencement of discharge planning; frequency of discharge activities; and barriers to efficient discharge planning in the inpatient mental health care setting. A review of relevant literature found overlap and a strong interrelationship in the concepts, definitions and key components of the discharge planning process and continuity of care. A questionnaire was developed for the study that was based on the themes and findings identified in the literature. Response scales were developed for most items on the questionnaire. Those questions without response scales sought participant comments related to particular sections within the questionnaire. Parametric testing of the data was undertaken using basic descriptive statistics, T-tests for matched pairs, reliability analysis of scales, and correlations. Comments provided by participants highlighted issues and gave additional meaning and depth to the quantitative data. The findings of the study identified a need for improved communication and care coordination between all stakeholders involved in the care and planning of discharge for people admitted to the acute inpatient mental health units. High bed demand and pressure to discharge patients prematurely was found to negatively impact on discharge planning. The study also identified a significant gap between actual and ideal involvement of stakeholders in the discharge planning process, and problems associated with timely and effective communication in everyday clinical practice. Barriers to efficient discharge planning were found to impact on the discharge process and limit involvement of patients, carers, hospital health care professionals and community care providers. The study concluded that inpatient mental health workers desire greater involvement in the planning of care, particularly as it relates to preparation for discharge. Perceptions of inequality in the level of involvement and care coordination within the multidisciplinary team lead to feelings of frustration and dissatisfaction, particularly among nurses. Stakeholders directly aligned with the inpatient setting tend to have more involvement in discharge planning than those stakeholders who are community based and who are external to the mental health service organisation. The study also concluded that when discharge planning begins earlier during hospitalisation, barriers related to time, ward factors and communication will have less of a negative affect on the outcome of discharge planning. Discharge planning becomes more effective when communication is more efficient, sufficient time is given to prepare, and relevant stakeholders (including hospital and community health care professionals, the patient and family) become involved earlier in the discharge planning process. Good discharge planning and the facilitation of continuity of care is regarded by mental health professionals as the responsibility of all stakeholders at all levels - this includes the organisation, individual mental health workers, the patient and their family and friends.

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