The experience of hospital discharge planning for informal caregivers of older people with dementia : an interpretative phenomenological analysis
O'Hana, Natalie (2019) The experience of hospital discharge planning for informal caregivers of older people with dementia : an interpretative phenomenological analysis. Doctoral thesis, London Metropolitan University.
hospitals; discharging from hospital; older people; elderly people; people with dementia
Abstract / Introduction
Whilst involving Informal Dementia Caregivers (IDC) in the Hospital Discharge Planning Process (HDPP) can reduce patients’ length of stay and readmissions, research has shown that their inclusion is scarce. Limiting IDC participation in decisions relating to their needs or the welfare of those they care for can yield adverse repercussions for their mental-health, disrupt continuity of care, extend patients’ hospital stay, and increase the likelihood of patients’ readmission to hospital. Given these costs it is imperative to comprehend how this particular client-group thinks and feels about the hospital discharge planning phenomenon. Nevertheless, minimal studies have investigated this topic area. In response to this gap in knowledge, the present thesis investigated the experience of the hospital discharge planning process for informal caregivers of individuals with dementia.
Data was harvested from participants via the employment of face-to-face semistructured interviews which were later verbatim transcribed. Participants idiosyncratic narratives were examined and analysed using Interpretative Phenomenological Analysis. The participants were five informal caregivers of older patients with dementia aged between 52 and 71 who took part in their care-recipient’ hospital discharge planning process.
Three superordinate themes emerged from the IPA analysis: 1) the negative aspects of the discharge planning process 2) focus on relationships and 3) employing coping mechanisms to counteract taxing experiences. It appears that the challenges that participants encountered in their meetings with hospital personnel and the changes they experienced in their interactions with their care-recipients, coupled with the costs they incurred in their daily life, triggered in them a range of negative thoughts and feelings which diminished from their psychological wellbeing. This propelled the participants to employ various coping strategies in an attempt to alleviate their internal turmoil. However, the efficacy of these tactics was questionable.
The experience of the HDPP for IDC comprises of multiple psychological dimensions. Nevertheless, the HDPP does not address IDC mental health needs. Therefore, this thesis suggests that counselling psychologists work as facilitators of psychological wellbeing on hospital wards. Such an initiative could provide caregivers access to mental health interventions in real time which they would struggle to attain in the community due to long waiting lists. Additionally, counselling psychologists and other applied psychologists should share their knowledge of therapy skills with hospital personnel in order to help staff form and maintain a nourishing relationship with IDC. Implications for future investigations and clinical work are also proposed.