title: 'Rapid discharge': issues for hospital-based nurses in discharging cancer patients home to die.
abstract: OBJECTIVE
  To explore issues for hospital-based nurses in arranging rapid home discharge for imminently dying cancer patients in a Singapore acute hospital.
  
  
  BACKGROUND
  Dying at home is an important measure of a 'good death'. For hospitalised terminally ill patients, achieving home death can be of paramount importance to them and their family. Nurses experience many challenges in discharging imminently dying cancer patients home, due to time limitations and complex needs of patients and their families.
  
  
  METHODS
  Qualitative interpretive description.
  
  
  METHODS
  Using purposive sampling, 14 registered nurses from an oncology ward in a Singapore hospital were recruited to participate in individual, semi-structured interviews.
  
  
  RESULTS
  Nursing issues in facilitating rapid discharge fell into three categories: time, discharge processes and family preparation. Decisions to die at home appeared solely family/patient driven, and were made when death appeared imminent. Discharge then became time-critical, as nurses needed to complete multiple tasks within short timeframes. Stress was further exacerbated by nurses' inexperience and the infrequent occurrence of rapid discharge, as well as absence of standardised discharge framework for guidance. Together, the lack of time and discharge processes to enable smooth hospital-to-home transition potentially affected nurses' capacity to adequately prepare families, and may contribute to caregiver anxiety.
  
  
  CONCLUSIONS
  Rapid discharge processes are needed as sudden patient/family decisions to die at home will continue. Earlier involvement of palliative care and implementation of a discharge pathway can potentially help nurses address their multiple responsibilities to ensure a successful transition from hospital to home.
  
  
  CONCLUSIONS
  Recognition of nursing issues and challenges during rapid discharge has implications for clinical improvements in supporting nurses during this challenging situation. Results of this study can be used to inform the conceptualisation of clinical interventions to facilitate urgent discharges of imminently dying patients.
authors.affiliation: Division of Palliative Medicine, National Cancer Centre Singapore, Singapore.
authors.forename: Yung Ying
authors.identifier: http://orcid.org/0000-0001-8703-7137
authors.initials: YY
authors.lastname: Tan
authors.affiliation: School of Nursing & Midwifery, La Trobe University, Bundoora, Vic., Australia.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Blackford
mesh_terms: D006801:Humans; D007407:Interviews as Topic; D009369:Neoplasms / Q000451:nursing*; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010351:Patient Discharge; D012846:Singapore; D013727:Terminal Care
keywords: death and dying; discharge; end-of-life care; oncology nursing; palliative care; qualitative study