The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals.

AIM: To explore discharge planning with a range of key stakeholders in subacute care, including consumers. DESIGN: Qualitative descriptive study. METHODS: Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically. RESULTS: The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education. CONCLUSION: Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge. IMPACT: This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. REPORTING METHOD: COREQ guidelines were followed in reporting this study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the design, data analysis or preparation of the manuscript.

Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives.

BACKGROUND: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. METHODS: A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. RESULTS: Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). CONCLUSIONS: These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.

Predictors of undergraduate occupational therapy students' academic performance during the Covid-19 pandemic: A hierarchical regression analysis.

BACKGROUND: The rapid switch to online learning in response to the Covid-19 pandemic affected occupational therapy students' education delivery. It is, therefore, important to investigate these impacts. AIMS/OBJECTIVES: This study investigated the potential predictors of academic performance in undergraduate occupational therapy students after moving to online or blended learning post-Covid-19. MATERIAL AND METHODS: A total of 208 students from three Australian universities completed a demographic questionnaire and the Distance Education Learning Environment Scale (DELES). Hierarchical linear regression analyses were completed to identify significant students' academic performance predictors. RESULTS: Hierarchical regression explained a cumulative total variance of 24.6% of students' academic performance. The following independent variables were significant predictors: DELES student autonomy (p = 0.033), number of hours per semester week dedicated to indirect online study (p = 0.003), number of hours per semester week dedicated to indirect offline study time (p = 0.034), gender (p = 0.005) and English as a first language (p = 0.045). CONCLUSIONS: The findings add to the knowledge base on the range of factors that have impacted occupational therapy students' academic performance during the Covid-19 pandemic. SIGNIFICANCE: The outcomes will assist faculty in developing supportive and pedagogically sound learning modes across online, hybrid and traditional forms of instruction within occupational therapy curricula.

Online Learning During the COVID-19 Pandemic: Comparing the Perceptions of Domestic and International Occupational Therapy Students.

PURPOSE: To investigate differences between domestic and international occupational therapy students in their perceptions and experiences of online learning during the COVID-19 pandemic. METHODS: Cross-sectional study of 151 occupational therapy students enrolled in the 4-year Bachelor of Occupational Therapy (Honours) courses at the University of Canberra and Monash University in Australia. Students completed the Student Engagement in the e-Learning Environment Scale (SELES) and the Distance Education Learning Environment Scale (DELES). Both instruments have established validity and reliability. ANOVA analysis with bootstrapping was completed to examine potential differences in domestic and international students' experiences and perceptions of online learning. RESULTS: Statistically significant differences were observed between domestic and international students' scores on the DELES Student Autonomy (p=0.001), Personal Relevance (p=0.001) and Student Interaction and Collaboration (p=0.037) subscales. CONCLUSION: International students experienced greater difficulties during online learning in relation to taking control of their own learning, connecting acquired knowledge with real-world settings, and forging collaborative and interactive working relationships with their peers. Academic, technological, and social support measures are recommended to strengthen students' self-directed learning skills, facilitate them to link what they have learned beyond online settings, and encourage active and collaborative engagement with peers and instructors.

'Learning in and out of lockdown': A comparison of two groups of undergraduate occupational therapy students' engagement in online-only and blended education approaches during the COVID-19 pandemic.

INTRODUCTION: In many countries, the COVID-19 pandemic resulted in sudden changes to the delivery of health professions education in response to local and national lockdowns. Within occupational therapy, university education programs traditionally delivered in face-to-face classroom, and clinical settings, the transition to online learning presented unique issues and challenges for faculty and students. This study compared the experiences and perceptions of learning in two groups of occupational therapy students during the pandemic: one group converted to online learning only and the other had a blended approach that combined face-to-face on-campus learning with some online lecture content delivery. METHODS: Two hundred and eight (n = 208) undergraduate occupational therapy students from three Australian universities completed an online self-report demographic questionnaire and two standardised instruments: the Student Engagement in the e-Learning Environment Scale and the Distance Education Learning Environment Scale. An independent-samples t test with bootstrapping was completed to examine differences in students' scores. RESULTS: Statistically significant differences were observed between the online and blended learning groups across a range of the SELES and DELES subscales. The strongest findings related to psychological motivation (p = 0.001), personal relevance (p = 0.001), interactions with instructors (p = 0.002), instructor support (p = 0.001), student interaction & collaboration (p = 0.001), and cognitive problem solving (p = 0.001). CONCLUSION: Occupational therapy students who transitioned to online-only learning experienced higher levels of motivation, interactions with instructors and peers, and self-directed learning than students who experienced a blended education delivery approach of face-to-face and online learning. The findings extend educators' understanding of the matrix of factors that have impacted students' education during COVID-19 and support the development of contemporary and pedagogically sound online and traditional modes of occupational therapy instruction. The results provide evidence of the importance of well-structured programs that facilitate active and flexible learning, provide meaningful and positive experiences, and promote initiatives safeguarding social and personal well-being. Further research in this area is recommended.

Defining discharge-readiness from subacute care from all stakeholders' perspectives: a systematic review.

PURPOSE: Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders' perspectives. METHODS: Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted. RESULTS: From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge. CONCLUSION: Despite limited literature defining sub-acute patients' discharge-readiness from all stakeholders' perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.IMPLICATIONS FOR REHABILITATIONDischarging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.Multiple factors need to be considered when considering the discharge readiness of an inpatient.Ensuring adequate social support is key to maximising transition from hospital to home.Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.