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A Critical Ethnography of the Process of Discharge Decision-Making for Elderly Patients

Published online by Cambridge University Press:  29 November 2010

Donna L. Wells
Donna L. Wells
Affiliation:
University of Toronto
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Abstract

A critical ethnography of the process of discharge decision-making for elderly patients was conducted to examine the nature of the process over the total course of patients' hospital stays. The focus was on describing the timing and conditions of decision-making, the related activities of professionals, professionals' perceptions of the process, and the effects of the process on those involved and on the hospital organization. Data analysis demonstrated that the process is not intricately linked with patients' clinical progress, that often inaccurate assumptions about the importance of patient-related clinical and social factors and organizational parameters underlie decisions, and that professionals' perceptions of the process are shaped by organizational imperatives. In the current process, resources are used inefficiently and humanitarian and ethical consequences arise for participants. The analysis supports attempts to achieve greater congruence between the discharge decision process and the patient's clinical progress so that the fiscal and humanitarian goals of the hospital can be achieved.

Résumé

Une ethnographie critique du processus de décision concernant le congé donné aux patients âgés a été effectué afin d'examiner la nature de ce processus en relation avec toute la durée du séjour de ces patients à l'hôpital. L'étude est centré sur la description du moment et des conditions entourant la prise de décision, les activités des professionnels à cet égard, leur perception du processus et finalement sur les effets du processus sur les personnes en cause et sur l'organisation de l'hôpital. Les résultats de l'analyse ont démontré que le processus n'est pas étroitement relié au progrès clinique des patients, que souvent, les décisions reposent sur des hypothèses inexactes concernant l'importance des facteurs cliniques et sociaux se rapportant aux patients et des paramètres organisationnels se rapportant aux patients et que la perception du processus qu'ont les professionnels se fonde sur des impératifs organisationnels. Dans l'état actuel des choses les ressources sont utilisés d'une manière inefficace et il en résulte des conséquences d'ordre humanitaire et moral pour les participants. L'analyse fournit une base pour des tentatives d'obtenir une meilleure concordance entre le processus d'autorisation de quitter l'hôpital et le progrès clinique du patient de sorte que les objectifs financiers et humanitaires de l'hôpital se réalisent.

Keywords

Elderly PatientsDischarge Decision-Making ProcessCritical EthnographyParticipant ObservationCritical TheoryPatients âgésprocessus décisionnel de congéethnographie critiqueobservation participantethéorie critique
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 16 , Issue 4 , Hiver/Winter 1997 , pp. 682 - 699
Copyright
Copyright © Canadian Association on Gerontology 1997

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