Heart failure (HF) is a diagnosis associated with significant mortality, morbidity, and healthcare costs. One in four patients with HF have an unplanned readmission within 30 days of discharge. Few interventions that seek to decrease readmissions target the discharge planning process during the acute hospitalization or account for the contributions of bedside nurses. Bedside nurses’ decision-making and motivation surrounding discharge planning for frequently readmitted patients with HF has not been described.
Therefore, the purpose of this interpretive descriptive study was to understand bedside nurses’ motivation and decision-making during discharge planning for adult patients with HF on a telemetry step-down unit within a large, Magnet-designated, Midwest hospital. In order to achieve the aims of this study, Self-Determination Theory (SDT) was used as the organizing structure. SDT is generally defined as the motivation to act based on the degree of 1) autonomy, 2) competence, and 3) relatedness felt by bedside nurses. Fifteen bedside nurses were interviewed. Coding was done using Nvivo and thematic analysis was completed. Two members of the research team reviewed the coding and a nurse consultant who was not interviewed reviewed the nurse researcher’s identification of themes related to the three domains of SDT: autonomy, competence, and relatedness.
The major finding was that bedside nurses described high levels of motivation to do effective discharge planning despite many barriers, such as lack of physician-nurse communication and "surprise" discharges. The nurses reported being motivated when they had a broader knowledge of methods to deliver HF education (felt competent), had time to establish a personal connection with patients (relatedness), and did not feel rushed to complete HF discharge planning tasks. Autonomy did not emerge from nurses’ responses to the degree that competence and relatedness did, but when it did emerge, a strong sense of autonomy was apparent (acting out of personal choice). Findings of this study emphasized a need for effective HF discharge planning to be established as an important competency for bedside nurses and for interdisciplinary relationship-building between nurses, patients, and physicians to be factored into the organizational culture. The SDT framework provided a unique lens to better understand the decision-making and motivation that bedside nurses have toward HF discharge planning and how work conditions can facilitate or constrain their natural tendencies to deliver effective patient-centered care to patients with HF.