How older people enact care involvement during transition from hospital to home: A systematic review and model
Abstract
BACKGROUND: Current models of patient-enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to 'reach-in' to complex health-care systems.
OBJECTIVE: To develop a dynamic and interactional model of patient-enacted involvement in care.
SEARCH STRATEGY: Electronic search strategy run in five databases and adapted to run in an Internet search engine supplemented with searching of reference lists and forward citations.
INCLUSION CRITERIA: Qualitative empirical published reports of older people's experiences of care transitions from hospital to home.
DATA EXTRACTION AND SYNTHESIS: Reported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding leads to the development of a new framework and thereafter a model representing changing states of involvement.
MAIN RESULTS: Patients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health-care professionals as they attempt to resolve health- and well-being-related goals. 'Non-involvement', 'information-acting', 'challenging and chasing' and 'autonomous-acting' were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion leads patients to act autonomously, creating the potential to cause harm.
DISCUSSION AND…
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