On discharge planning: dynamic complex processes – uncertainty, surprise and standardisation

Abstract

How can discharge planning (DP) for patients who require care in the home following a period in hospital be understood and developed through the lenses of complexity theory? With the help of complexity theory and practice-based narrative research this study discloses the formal routines and complex dynamic practices that are associated with DP. A study of the literature established that there was an almost total absence of complexity-theoretical perspectives on interpreting and developing DP. The researchers collected narratives about the DP processes using qualitative interviews with the nurses responsible for this in a hospital ward: these were audio-recorded and transcribed verbatim. They also participated in and documented meetings where these nurses, as a group, discussed DP. The findings show that nurses have to continuously deal with uncertainty, surprises and the unknown. They have to make sense and take charge of dynamic complex events and new knowledge, and manage complex relations and information. The researchers argue that looking upon practice from the lenses of complexity theory, and therefore accepting the complexity of practice, could facilitate the development of nurses' skills in order to guarantee good quality in DP.