The enactment of patient education for complex inpatients over the course of a stay in an interprofessional internal medicine inpatient unit
Abstract
This study seeks to provide insights on how patient education (PE) is enacted in an inpatient Internal Medicine Inpatient Unit at an academic teaching hospital in Ontario, Canada that has adopted Patient Oriented Discharge Summaries (PODS). A constructivist grounded theory methodology was conducted for 106 participant observations and 25 field interviews. We found that (1) patient education was not a single event but occurred at multiple moments throughout the course of care, and many components were required for PE to be effective (2) In addition to needing everyone in the same room, there needed to be an alignment of goals and concerns between the health care providers (HCPs), patients (Pts) and family advocates (FAs) (3) Team logistics and schedules meant that the same category of HCPs were present but not the individuals themselves (4) Though PODS functioned poorly as a boundary object, we found other documents/people who played the role of boundary. This study identifies a host of features that need to be attended to for effective re-engineering of inpatient PE throughout a hospital stay. Designing a better system for PE in the IMIU requires addressing all the levels of complexity as the current re-engineered discharge tools do not adequately address the barriers to having a PE conversation at the point of discharge.