Author: Ho, Yuk-lai Ester
Title: To stay or not to stay : an ethnographic study of hospital discharge
Advisors: Ku, Hok Bun (APSS)
Degree: DHSc
Year: 2018
Subject: Hong Kong Polytechnic University -- Dissertations
Hospitals -- Admission and discharge -- China -- Hong Kong
Hospital patients -- China -- Hong Kong -- Attitudes
Department: Faculty of Health and Social Sciences
Pages: pages : color illustrations
Language: English
Abstract: The subject of hospital discharge is one of the main concerns of healthcare services currently. Many countries have developed planning systems to facilitate the discharge process; while in Hong Kong, it is under active construction. Although patient and family perspectives on hospital discharge are always regarded as important elements in enhancing the discharge process, research in this specific area remains scanty. Hospital discharge is a complex issue. To inform practice, there is a need to study patient and family perspectives on hospital discharge. Given its complexity, a qualitative methodology in form of evocative ethnography is adopted, which may not be commonly used in the field of healthcare research and practice in Hong Kong, but is yet to be explored. Objectives: The objectives of this study are: (1) to understand patient and family perspectives on hospital discharge, (2) to explore what healthcare workers can do for them based on their perspectives to facilitate the discharge process. And finally, (3) to revisit evidence-based practice, looking for ways to enhance the practice of medicine and healthcare services.
Methods: Methodology: An ethnographic, exploratory, interpretative, qualitative field study Field Site: A rehabilitation unit of a local hospital in Hong Kong Data Collection: Participant observation, face-to-face formal interviews and archival search were used to collect data. Participant observation data was collected from Mondays to Fridays, 9am to 5pm. Additional time slots were arranged during meal times, evenings, weekends and public holidays. Over the 5-month of data collection, there were 66 entries with 46 patients being mentioned in the field notes. Apart from this, a total of 9 patients were formally interviewed, with 4 of them being accompanied by their family members. Each interview lasted for around 45 minutes. Data Analysis: Data was analyzed qualitatively, being carried out concurrently with data collection. Observation and informal interview notes were typed out and expanded. Formal interview recordings were selectively transcribed for textual analysis on an on-going basis. Findings: People were longing for discharge, but not everyone was ready to be discharged. The non-readiness was commonly due to the limitations of patients' physical abilities; their home and social environments; and the abilities of their family caregivers in taking care of them. These were frequently mentioned in literatures. While, the new understandings were: In time of illness, the main concern of the patients was the rite of passage. People were longing for discharge because they were longing to recover in order to discharge. What really mattered to them was recovery. Discharge could be just a sign of that matter. Discharge could be a joyful experience for those with positive thinking, which is subjectively constructed (Scheier & Carver, 1993). It is possible for healthcare workers to construct it. Indeed, it is the core of rehabilitation (Kabat, 1950) as what physiotherapists have been doing everyday invisibly under the current legitimate framework of modernization. Conclusion: Hospital discharge is not a main concern of the patients, but the rite of passage. What really matter to them is recovery. Discharge is just a sign of that matter. Apart from provision of technical support, what healthcare workers can do is to keep our gaze on what really matters to them by providing hope and care in helping patients to recover through rehabilitation and reviewing our current practice with reflection.
Rights: All rights reserved
Access: restricted access

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