Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

Files in This Item:
File Description SizeFormat 
integrative_review_manuscript r1 1.8.13 pre print.pdf666.04 kBAdobe PDFDownload
Title: Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development
Authors: Noyes, JaneBrenner, MariaFox, Patricia A.Guerin, Ashleigh
Permanent link: http://hdl.handle.net/10197/9086
Date: May-2014
Online since: 2017-12-12T12:19:53Z
Abstract: AIM: To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. BACKGROUND: Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking.DESIGN:Novel mixed-method integrative review informed by health systems theory. DATA SOURCES: CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW METHODS:Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development.RESULTS: Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. CONCLUSION: The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models.
Type of material: Journal Article
Publisher: Wiley
Journal: Journal of Advanced Nursing
Volume: 70
Issue: 5
Start page: 975
End page: 996
Copyright (published version): 2013 Wiley
Keywords: Systematic reviewsIntegrative reviewHealth systems theoryTehcnology-dependentChildrenCommunity nursingComplex home careComplex discharge planningNurse-led care
DOI: 10.1111/jan.12278
Language: en
Status of Item: Peer reviewed
This item is made available under a Creative Commons License: https://creativecommons.org/licenses/by-nc-nd/3.0/ie/
Appears in Collections:Nursing, Midwifery & Health Systems Research Collection

Show full item record

SCOPUSTM   
Citations 20

13
Last Week
0
Last month
1
checked on Sep 12, 2020

Page view(s)

686
Last Week
2
Last month
14
checked on Mar 6, 2021

Download(s) 50

384
checked on Mar 6, 2021

Google ScholarTM

Check

Altmetric


If you are a publisher or author and have copyright concerns for any item, please email research.repository@ucd.ie and the item will be withdrawn immediately. The author or person responsible for depositing the article will be contacted within one business day.