Abstract：
BACKGROUND: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses\' efforts may be essential in ensuring a successful discharge.
OBJECTIVE: To explore the process of preparing discharge for patients with COPD in a hospital setting.
METHODS: Using constructivist grounded theory, we observed 11 nurses\' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical.
RESULTS: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues\' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike.
CONCLUSIONS: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
OBJECTIVE: To explore the process of preparing discharge for patients with COPD in a hospital setting.
METHODS: Using constructivist grounded theory, we observed 11 nurses\' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical.
RESULTS: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues\' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike.
CONCLUSIONS: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
摘要：
背景：目前尚不清楚为什么在丹麦医院接受治疗的慢性阻塞性肺疾病（COPD）急性加重的患者中有17%在30天内再次入院。出院是多方面的。然而,准备过程和护士的努力对于确保成功出院至关重要。
目的：探讨住院COPD患者出院准备过程。
方法：使用建构主义扎根理论，我们使用参与者观察法观察了两个肺部医学病房的11名护士的工作。数据收集和分析使用持续的比较过程进行，包括三个阶段：初始，有针对性和理论性。
结果：我们确定了COPD患者从两个肺部内科病房出院时影响护士的重要观点。我们产生了关于护士如何将各种观点整合到出院处理中的实质性理论。该理论包含三种放电方法：共同创造，犹豫和社交。共同创造方法侧重于患者和相关参与以及系统的任务解决方案，嵌入生物心理社会过程中，旨在实现安全和可持续的排放。相比之下,犹豫不决的方法侧重于根据系统要求和同事的期望出院。最后,社交方法侧重于为患者和同事创造愉快的出院体验。
结论：本研究阐明了护士在为COPD患者出院时采用的三种不同方法。共同创造过程包括患者参与和系统的任务解决，结合了生物心理社会过程。相比之下,其他方法在范围上更有限:犹豫的方法旨在和谐和合议，而社交方法侧重于确保每个人都有愉快的出院体验。因此，护士应注意他们采用的方法以及与之相关的价值观，以优化他们对出院流程的管理。
目的：探讨住院COPD患者出院准备过程。
方法：使用建构主义扎根理论，我们使用参与者观察法观察了两个肺部医学病房的11名护士的工作。数据收集和分析使用持续的比较过程进行，包括三个阶段：初始，有针对性和理论性。
结果：我们确定了COPD患者从两个肺部内科病房出院时影响护士的重要观点。我们产生了关于护士如何将各种观点整合到出院处理中的实质性理论。该理论包含三种放电方法：共同创造，犹豫和社交。共同创造方法侧重于患者和相关参与以及系统的任务解决方案，嵌入生物心理社会过程中，旨在实现安全和可持续的排放。相比之下,犹豫不决的方法侧重于根据系统要求和同事的期望出院。最后,社交方法侧重于为患者和同事创造愉快的出院体验。
结论：本研究阐明了护士在为COPD患者出院时采用的三种不同方法。共同创造过程包括患者参与和系统的任务解决，结合了生物心理社会过程。相比之下,其他方法在范围上更有限:犹豫的方法旨在和谐和合议，而社交方法侧重于确保每个人都有愉快的出院体验。因此，护士应注意他们采用的方法以及与之相关的价值观，以优化他们对出院流程的管理。
