P-630: Opening the black box of nursing discharge teaching of older inpatients: a rapid realist review

摘要

Background: Discharge teaching by nurses is the primary mechanism for preparing older inpatients for hospital discharge, yet, once at home, patients and families report that the information is often insufficient. Implementation of evidence-based practices in discharge teaching remains unsatisfactory. A realist approach on patient-nurse interaction in discharge teaching is crucial to understand what elements, actors, context and hidden mechanisms are enable nurses to provide effective discharge teaching. Aims: A rapid realist review was conducted to develop a programme theory that explains context, mechanism and outcome (CMO) configurations of discharge teaching. Method: Realist review is a theory-driven approach to identifying, characterising and systematically synthesising the literature to explain the effect of context on complex interventions mechanisms. Results: Ten CMO were identified which cumulatively refined a programme theory about how discharge teaching results in positive outcomes for older inpatients. The CMO indicate, for instance, how to ensure the relevancy and the understandability of the teaching content, what helps patients make sense of the information, and how to engage them in the learning process. Key conclusions: This rapid realist review is the first to explain how nursing discharge teaching works for older inpatient. It allows teaching to be adapted to the needs and priorities of the patient according to his or her level of activation. Such knowledge can guide nurses towards operational improvements that will create healthcare environments more supportive of older patient teaching.