Older persons' experiences of hospital patient education and self-management of their chronic diseases once discharged home
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The purpose of this hermeneutic phenomenological study was to explore elderly patients’ perspectives regarding discharge instructions related to self-management of their chronic illnesses once they were discharged from the hospital to their home. The combination of the growing elderly population, inadequate health literacy, and the prevalence of comorbidity illustrate the complex needs of this population of patient in regards to self-management of chronic illnesses once discharged (National Research Council of the National Academies, 2012). Study participants were recruited from two cardiovascular hospital-based clinics located in a large medical center in Texas. A purposive sampling was used to secure a sample of 20 participants meeting the following inclusion criteria: older than 65 years of age, diagnosis of any type of cardiovascular disease, cognitive competence, length of stay in the hospital greater than 3 days, discharged home rather than to long term care facility or nursing home, first follow-up doctor visit 2-4 weeks after discharge from the hospital and English speaking. Data were collected using a demographic questionnaire, a cognitive screening test (Mini Cog) and semi-structured audio-recorded interviews that lasted approximately 30-45 minutes. Trustworthiness was established using Lincoln and Guba’s framework (1985) to secure credibility, transferability, dependability, and confirmability. Analysis was conducted using the Lindseth and Norberg’s (2004) hermeneutical interpretation method which includes three steps: naïve reading, structural analysis and comprehensive understanding. A major finding was that patients’ perceptions of their discharge instructions did not match the reality of their post-discharge needs. Four themes emerged, reflecting aspects about transition from hospital to home: Just-in-time Discharge Process, I Thought the Instructions Were Good, But…, What Would I do Without My Caregiver, and It Would Help If I Had… This study identified gaps in discharge instructions and the degree to which they did or failed to prepare elderly patients to self-manage their chronic illness once discharged home. Such gaps potentially result in poor self-management and subsequent rehospitalization. Without strengthening the hospital discharge instruction process, self-management of illness in the elderly patient population will continue to be a major challenge.