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Title of Systematic Narrative
Review
Service user involvement in 'best
interest' decisions during
discharge from hospital
Abstract
Context
This review examined how practice can be developed, to better involve
service users in 'best interest' decisions during discharge from hospital.
Methods employed in the review
Research articles were retrieved from 3 databases. Research was selected
based on relevance. Only peer reviewed journals were included from the
past 15 years. Two of the research studies were quality appraised using a
formal appraisal tool. The principles of this tool were also informally applied
to all the research articles and information collected using an extraction
table. The research was synthesised based on commonalities found
amongst the studies.
Findings
It is evident that a whole systems approach is required to promote service
user involvement (SUI). An individual assessment of the service user's
needs is required and establishment of their preferred level of participation.
There also needs to be recognition for the importance of the hospital social
worker role and the need to address power imbalance. Organisations need
to consider SUI from the outset in the development of policy and
procedures. Achieving SUI is beneficial as it increases satisfaction, reduces
length of stay in hospital, reduces adversities and avoids readmission.
Conclusions
The review evidenced a number of challenges in achieving SUI for both the
service user and the professional. It also raised awareness of organisational
influence. Suggested improvements for practice include the introduction of
person centred approaches in relation to SUI, effective communication and
staff training. Better consideration also needs to be given to advanced and
shared decision making methods, to include service users without capacity
in the decision making process.
There is a need for further social work research in the hospital setting and
inclusion of service users with severe cognitive impairment in research. The
use of a service user forum, a hospital based independent advocate and
the development of a participation tool are suggested methods to develop
practice in Northern Ireland.