title: Thinking about the patient's wishes: practical wisdom of discharge planning nurses in assisting surrogate decision-making.
abstract: BACKGROUND
  The accelerating trend towards shorter hospital stays in Japan has made modes of decision-making essential for effective patient transition from the hospital to recuperation in the regional community, and the ageing of the population has brought a rise in surrogate decision-making by the families of patients lacking decision-making ('self-decision') capacity.
  
  
  OBJECTIVE
  To verbalise and elucidate the practical wisdom of discharge planning nurses by focusing on the perceptions and judgements, they apply in practice and describing their methodology in concrete terms.
  
  
  METHODS
  Participants were six discharge planning nurses and one person with previous experience as a discharge planning nurse, all working at discharge planning departments of acute care hospitals. Separate, semi-structured, interactive interviews were conducted with each participant. The study design was qualitative descriptive in form with qualitative content analysis. All participants provided written informed consent to participate in the study, which was approved by the study institution.
  
  
  RESULTS
  Three concepts were extracted as the basis for discharge planning nurses' perception and judgement at acute care hospitals: working for mutual envisionment of the available postdischarge options; helping the family act as spokesperson(s) for the patient's wishes; and understanding the family inclusive of the patient as a relationship of strongly interaffecting interests.
  
  
  CONCLUSIONS
  The practical wisdom of the nurse, working in mutual envisionment with the family, and collaborative decision-making through discussion with those who know the patient, leads to rational discharge assistance.
authors.affiliation: School of Nursing, University of Shizuoka, Shizuoka, Japan.|Department of Nursing, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kageyama
authors.affiliation: Department of Nursing, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Asano
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D009741:Nursing Staff, Hospital; D010351:Patient Discharge
keywords: decision-making; discharge planning; discharge planning nurse; family; practical wisdom; surrogate