Going home from hospital: the carer/patient dyad.
OBJECTIVE
This study aimed to provide an in-depth understanding of the process of hospital discharge experienced by the carers of patients 'at risk' of unsuccessful discharge from medical wards in three hospitals in the North of England.


BACKGROUND
The Community Care Act and the Carers Recognition and Services Act placed responsibility on service providers to ensure the smooth discharge of patients from hospital making sure that appropriate community services are in place to support the patient and their informal carer following discharge from hospital. The study, from which this paper is taken, identified patients at risk of unsuccessful discharge and tracked the experiences of the patient and their carer through the discharge process. For the purpose of the study unsuccessful discharge is defined as unplanned readmission within 6 weeks of discharge or extended length of stay.


METHODS
The study combined qualitative and quantitative methods to identify factors leading to unsuccessful discharge. Logistic regression was used retrospectively with the records of 1500 patients to identify factors predicting unsuccessful discharge. A sample of medical patients predicted to be at risk of unsuccessful discharge, their formal and informal carers, were followed through the discharge process using qualitative techniques to look at decision-making and outcomes related to discharge.


RESULTS
This paper presents findings relating to patient/carer experiences of the discharge process. It explores the obligate moral climate in which the role of carer is negotiated between professionals, patients, family members, friends and neighbours and the differing assumptions about duty associated with caring roles in hospital and in family and community settings.


CONCLUSIONS
The discussion adopts a critical theory perspective to examine the contradictions confronting practitioners, patients and carers arising from hospital policies which promote cost-effective and efficient use of expensive technical resources while simultaneously seeking to identify and meet the needs of patients and carers for care.
Procter
S
S
Nursing Research and Development Unit, University of Northumbria at Newcastle, Newcastle upon Tyne, UK. susan.procter@unm.ac.uk
Wilcockson
J
J
Pearson
P
P
Allgar
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003657:Decision Making; D004739:England; D004993:Ethics, Nursing; D005260:Female; D006701:Home Nursing; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010347:Patient Care Planning; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D018570:Risk Assessment