Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, DNSc, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN; Caroline Etland, PhD, RN


nursing, older adults, acute care


Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was intended to explore how older adult patients (age 65 years and older) and their informal caregivers implemented discharge instructions following discharge. A qualitative methodology was used to conduct this study.
The primary aims of this study were to:
1. Describe how discharge instructions were implemented in the home setting by adults 65 years of age and older and their caregivers following an acute care hospital discharge.
2. Identify perceived facilitators and barriers to implementation of discharge instructions among older patients and their informal caregivers.
In-depth, semi-structured interviews were conducted with older adults and their informal caregivers within seven days of discharge from an acute care facility. This grounded theory study used an emergent qualitative paradigm, specifically social constructivist grounded theory. Emergent methods were appropriate for a study designed to bring emerging properties of an understudied phenomenon to light. Interviews were recorded and transcribed by a professional transcriptionist. In keeping with social constructivist grounded theory, constant comparative data analysis was conducted as the interviews were completed.
Study results demonstrated that participants knew they have been given discharge instructions, but once home the discharge instructions were not necessarily followed. Three study themes emerged and included a) Transitioning Hospital to Home Process, b) Knowing Their Life Was Resuming Again, and c) The New Normal. Recommendations for future research include expanding the setting beyond one hospital and investigating the novel study subtheme of attention-distraction.

Document Type

Dissertation: Open Access