An-Najah National University 

 

Faculty of Graduate Studies 
 

 

 

 

 

 

NURSES’ PERCEPTION OF THE DISCHARGE 

PLANNING PROCESS FOR ADULT PATIENTS IN 

AN ACUTE MEDICAL CARE DEPARTMENTS IN 

RAMALLAH HOSPITALS 
 

 

 

 

 

 
By 

Ali Thaher Mohamed Gawabreh 

 

 

 

 
Supervisor 

Dr. Wafa Menawi 

 

 

 
 

This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree 

of Master of Public Health Management, Faculty of Graduate Studies, An-Najah 

National University-Nablus, Palestine . 
 

2023 



ii 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

NURSES’ PERCEPTION OF THE DISCHARGE 

PLANNING PROCESS FOR ADULT PATIENTS IN 

AN ACUTE MEDICAL CARE DEPARTMENTS IN 

RAMALLAH HOSPITALS 
 

By 

Ali Thaher Mohamed Gawabreh 

 

This Thesis was defended successfully on 18/10/2023 and approved by: 

 

 



iii 

Dedication 

This thesis work is dedicated to the sake of Allah, my Creator, and my Master. My great 

teacher and messenger, Prophet Mohammed (May Allah bless and grant him), who 

taught us the purpose of life, 

To my beloved father, who had always loved me unconditionally 

and whose good examples had taught me to work hard for the things that I aspire to 

achieve. 

 To my beloved mother, who has been a constant source of support and 

encouragement during the challenges of graduate school and life. I am truly thankful for 

having you in my life. 

 To my admired sisters and brothers, and 

To my supervisors and all who supported me in completing this work, and to my 

supervisor, Dr. Wafaa Al-Minawi, may God bless her soul. To everyone who helped me 

complete this work. 

 



iv 

Acknowledgements 

First, all praise is to Allah, who has enabled me to complete this thesis on time. Although 

it would be impossible to individually name all the people and events that contributed to 

the success of this thesis and the accomplishment of a remarkable educational and 

experiential milestone, we know their value and appreciate each one. 

Next, I express my appreciation to Dr.Wafaa Menawi for her diligent supervision, clear 

guidance, and thoughtful mentoring throughout this thesis. Thank you. 

My warm appreciation is expressed to my family, respectful parents, brothers, and sisters, 

who have supported me throughout my educational journey. What a pleasure it has been! 

Special thanks go to my friends for their support in sharing and participation, which were 

the most truly welcomed. 



v 

Declaration 

I, the undersigned, declare that I submitted the thesis entitled: 

NURSES’ PERCEPTION OF THE DISCHARGE 

PLANNING PROCESS FOR ADULT PATIENTS IN 

AN ACUTE MEDICAL CARE DEPARTMENTS IN 

RAMALLAH HOSPITALS 
 

I declare that the work provided in this thesis, unless otherwise referenced, is the 

researcher’s own work, and has not been submitted elsewhere for any other degree or 

qualification. 

 

  Student's Name:  

 Signature: 

  Date: 

 

 

 

 

 

 

 

 

 

Ali Thaher Gawabreh 

 



vi 

List of Contents 

 

Dedication ......................................................................................................... iii 

Acknowledgements ............................................................................................iv 

Decleration ………………………………………………………………………………v 

List of Contents ..................................................................................................vi 

List of Tables .....................................................................................................ix 

List of Figures ..................................................................................................... x 

List of Appendices .............................................................................................xi 

Abstract ............................................................................................................ xii 

Chapter One: Introduction and Theoretical Background ..................................... 1 

1.1 Introduction ................................................................................................... 1 

1.2 Problem statement ......................................................................................... 3 

1.3 The importance of the Study ......................................................................... 4 

1.4 Aim of the Study ........................................................................................... 5 

1.5 Study Objectives ........................................................................................... 5 

1.6 Questions of study ......................................................................................... 5 

1.7 Concepts and operational definition .............................................................. 6 

1.8 Previous Studies and Theoretical Background .............................................. 7 

1.8.1 Global Studies ............................................................................................ 8 

1.8.2 Regional Studies ...................................................................................... 17 

1.8.3 Local studies ............................................................................................ 18 

1.9 Summary ..................................................................................................... 19 

Chapter Two: The Method ................................................................................ 20 

2.1 Study design ................................................................................................ 20 

2.2 Study setting ............................................................................................... 20 

2.3 Study population ......................................................................................... 20 

2.4 Study Sample .............................................................................................. 20 

2.5 Study time frame ......................................................................................... 21 

2.6 Data collection tool ..................................................................................... 21 

2.7 Validity and Reliability of the Questionnaire .............................................. 22 

2.8 Study procedures ......................................................................................... 24 

2.9 Data Analysis .............................................................................................. 25 

2.10 Ethical considerations ............................................................................... 25 

2.11 Inclusion and exclusion criteria: ................................................................ 26 



vii 

2.12 Study variables .......................................................................................... 26 

Chapter Three: Results ...................................................................................... 28 

3.1 Demographic characteristics of the nurses .................................................. 28 

3.2 Numbers of dscharges per week .................................................................. 29 

3.3 Nurses' perceptions of the DP process ......................................................... 29 

3.4 Who should co-ordinate discharge planning and the timing of discharge ... 31 

3.5 Specific skills are needed by nurses to carry out discharge planning .......... 33 

3.6 Discharge planning management ................................................................ 33 

3.7 Barriers to conducting effective discharge planning ................................... 35 

3.7.1 Internal discharge planning systems ......................................................... 35 

3.7.2 External discharge planning systems ........................................................ 37 

3.8 Management/personal skills ........................................................................ 37 

3.9 Differences in perceptions related to the DP among the  nurses .................... 38 

3.10 Differences in perceptions related to who should coordinate discharge 

planning and the timing of discharge ......................................................... 38 

3.11 Differences in perceptions related to important management and personal skills ........ 38 

3.12 Differences in  perceptions related to discharge planning management ..... 38 

3.13 Differences in perceptions toward internal discharge planning systems that 

form barriers to conducting effective discharge planning ........................... 39 

3.14 Differences in perceptions toward external discharge planning systems that 

form barriers to conducting effective discharge planning and experience . 39 

3.15 Differences in perceptions toward the role of management and personal skills

 .................................................................................................................... 39 

3.16 Differences between types of hospitals in terms of discharge planning 

overall mean score ...................................................................................... 39 

3.17 Correlation between nursing perceptions around the DP process and other 

dependent variables .................................................................................... 39 

3.18  The association between the perceptions of the discharge planning process 

for adult patients from  who coordinates , skills and the barriers to effective.40 

Chapter Four: Discussions and Conclusions ..................................................... 41 

4.1 Participants’ Socio-demographic Characteristics ........................................ 41 

4.2 Perceptions around the DP among the nurses .............................................. 41 

4.3 Timeing and implementation of discharge planning ................................... 42 

4.4 Barriers that affect the effectiveness of discharge planning ........................ 43 

4.5 Management/personal skills ........................................................................ 44 

4.6 The relationship between the perceptions of the discharge planning process 

for adult patients from  who coordinates , skills and the barriers to effective.45 



viii 

4.7 Association between participant characteristics and perceptions toward 

important management and personal skills .................................................. 46 

4.8 Association between participant characteristics and internal discharge planning ...... 46 

4.9 Association between participants characteristics and external discharge 

planning systems ........................................................................................ 47 

4.10 Limitations of the study ............................................................................ 47 

4.11 Strength of the study ................................................................................. 47 

4.12 Conclusion ................................................................................................ 48 

4.13 Recommendations of the Study ................................................................. 49 

4.13.1 Hospitals,Health policymakers ............................................................... 49 

4.13.2 Nurses’ Education and Practice ............................................................. 49 

4.13.3 The third level concerns the individual in terms of implementing discharge 

plans correctly   :  ........................................................................................ 49 

4.13.4 Ministry of Health in the Palestinian and Research: ............................... 50 

List of Abbreviations ........................................................................................ 51 

References......................................................................................................... 52 

Appendices ....................................................................................................... 56 

 ب ................................................................................................................. الملخص

 

 

 

 

 

 



ix 

List of Tables 

Table 2.1: 5 Points Likert Scale Table .............................................................. 22 

Table 2.2: Reliability coefficients for the various domains ............................... 23 

Table 3.1: Demographic characteristics of the nurses ....................................... 28 

Table 3.2: Number of discharges per week ....................................................... 29 

Table 3.3: Perceptions of the DP process among nurses ................................... 30 

Table 3.4: Who should co-ordinate discharge planning and the timing of 

discharge .......................................................................................... 32 

Table 3.5: Management and personal skills ...................................................... 33 

Table 3.6: Discharge planning management ..................................................... 34 

Table 3.7.1: Internal discharge planning systems .............................................. 36 

Table 3.7.2: External discharge planning systems ............................................. 37 

 



x 

List of Figures  

Figuer 1: Sudy procedures ................................................................................ 24 

Figure 2: Study variables .................................................................................. 27 

 

 

 



xi 

List of Appendices 

Appendix A: IRB approval ............................................................................... 56 

Appendix B: Books to facilitate the task of private and governmental hospitals in 

Ramallah ...................................................................................... 57 

Appendix C: Previous Studies and Theoretical Background ............................. 62 

Appendix D: Consent form (English version) ................................................... 66 

Appendix E: Consent form (Arabic version) ..................................................... 67 

Appendix F: Questionnaire (English version) ................................................... 68 

Appendix G: Questionnaire (Arabic version) .................................................... 71 

Appendix H: Tables .......................................................................................... 74 

Table 3.8: Management/personal skills ............................................................. 74 

Table 3.9: Differences inperceptions around the the DP in the participants ...... 74 

Table 3.10: Differences inperceptions about who should coordinate discharge 

planning and the timing of discharge ............................................... 75 

Table 3.11: Differences in perceptions related to important management and 

personal skills ................................................................................... 76 

Table 3.12: Differences inperceptions toward discharge planning management

 ......................................................................................................... 77 

Table 3.13: Differences in perceptions toward internal discharge planning 

systems that form barriers to conducting effective discharge planning

 ....................................................................................................... 78 

Table 3.14: Differences inperceptions toward external discharge planning 

systems that form barriers to conducting effective discharge planning

 ....................................................................................................... 79 

Table 3.15: Role of management/personal skills in preventing conducting 

effective discharge planning ............................................................. 80 

Table 3.16: Differences between types of hospitals in terms of discharge planning 

overall mean score ........................................................................... 80 

Table 3.17: Correlation between nursing perceptions around the discharge 

planning process and other dependent variables ............................... 81 

Table 3.18: The association between the perceptions of the discharge planning process 

for adult patients from  who coordinates, skills and the barriers to effective 

.………………………………………………….…………………………81 

 

 
 



xii 

NURSES’ PERCEPTION OF THE DISCHARGE PLANNING 

PROCESS FOR ADULT PATIENTS IN AN ACUTE MEDICAL 

CARE DEPARTMENTS IN RAMALLAH HOSPITALS 
 

 By 

Ali Thaher Mohamed Gawabreh 

Supervisor 
Dr. Wafa Menawi 

 

Abstract 

 Introduction: Discharge planning is an integral part of patient care in hospital 

departments because the goal for all patients is that they will leave this setting once acute 

healthcare needs have been managed or it is clear what the next phase of care will be. All 

patients who leave hospitals require discharge planning. The discharge planning is 

different for each patient as a result of the different needs after discharge, from simple 

and straightforward needs to more complex requirements . 

Aim: To investigate the nurses’ perception of the discharge planning process for adult 

patients in acute medical care departments in Ramallah hospitals. 

Method: 400 modified questionnaires were distributed to fit this study to 400 nurses 

working in acute departments in several hospitals in Ramallah. 

Results: The survey consisted of 300 nurses, with a response rate of 75%. 50.7% of the 

nurses participating in the study were male; 53.3% of them work in government hospitals. 

Also, most study participants are registered nurses (61.7%), as well as full-time 

employees (83.3%) and (54.3%) with experience of 5 years or less. 63.8% of nurses have 

perceptions about discharge planning, and 74.2% are familiar with the coordination of 

discharge planning and the timing of discharge. In the multivariate analysis models, 

perception was a strong predictor for discharge planning, skills, and barriers. 

Conclusion: The results showed a Preparing or implementing discharge planning is one 

of the tasks of the nurse following up on the patient. and implementing a discharge plan 

effectively requires nurses' administrative or interpersonal skills. In addition, future 

research should be directed toward discovering factors that improve the discharge process, 

and it is recommended that frequent nursing development courses be established in the 

communication process, especially in cases of developing discharge planning for patients. 

Keywords: Discharge Planning, Adult Patients, Acute Medical Care. 



1 

Chapter One 

Introduction and Theoretical Background 

This chapter describes and gives an overview of the problem under investigation. It starts 

with the study's introduction, then the problem statement, the importance of the study, the 

aim, the objectives, the questions, and the study's hypothesis. Next, it is followed by the 

conceptual and operational terms of the study, previous studies, and the theoretical 

background. 

1.1 Introduction 

Discharge planning is an integral part of patient care in hospital departments because the 

goal for all patients is that they will leave this setting once acute healthcare needs have 

been managed or it is clear what the next phase of care will be. All patients who leave 

hospitals require discharge planning. The discharge plan is different for each patient as a 

result of the different needs after discharge, from simple and straightforward needs to 

more complex requirements (Waring, et al., 2015). 

There are several definitions of discharge planning, and among these definitions, as 

mentioned by (Peter, et al., 2015),  developing a discharge plan for a patient in the hospital 

is for the patient to move from one stage of care to another stage of care. Methods of 

providing discharge plans are either in the form of information, instructions, or individual 

steps given to the patient. It coincides with the transition from parishes provided in the 

hospital to parishes at home. Or discharge plans are offered to anyone serving as a health 

care provider while the patient is transitioning to a long-term care setting. 

After conducting the study, it came out that every patient who is admitted to the hospital 

requires a variety of services and comprehensive care, and that the methods used to 

provide DP vary. For example, there are some discharge plans that can be predicted, such 

as direct surgeries (hand or knee surgery), and this is supported by knowing the patient's 

requirements after discharge from the hospital. Discharge planning can be programmed, 

coordinated, and advanced in advance. A simple example is that discharge questionnaires 

are prepared and given before a plan is made for the patient’s admission to the hospital to 

undergo surgery (Hansen, Young, Hinami, Leung, & Williams, 2011). 



2 

Many health care providers and specialists are involved in hospital DP, but the majority 

of those involved in the care of acutely ill patients and discharge planning are physicians 

and nurses. (Hofflander et al., 2016). 

Each health care provider plays a role in discharge planning, but nurses have the largest 

role in discharge planning. Nurses’ role is a continuous link with the patient, and they 

deal with the patient more than other health care providers (Gane, et al., 2022). 

Preparing or starting to plan for patients' discharge from the hospital is the most prominent 

and priority role for nurses, especially in departments that provide care for a limited and 

clear period, which are called acute. For 20 years, discharge planning has been considered 

a problem in Europe and North America, despite research aimed at improving and solving 

the problem of exit planning (Gane, et al., 2022).  

In some health centers and hospitals, a nurse called the Nurse Discharge Coordinator is 

assigned to the various wards and focuses specifically on managing discharge planning. 

Its task is to determine patients' needs at admission and coordinate the patient's discharge 

plan on the day of discharge from the hospital (Connolly, et al., 2009). 

Through the tracking of reviews to observe the effectiveness of discharge planning during 

the past ten years, it was found that the evidence of the effects of discharge planning is 

its role in reducing the patient’s stay in intensive care departments, especially acute ones. 

Of course, this leads to reducing the costs resulting from that, and it also reflects on the 

patient’s health after leaving the hospital, which leads to reducing or eliminating the 

unexpected return of the patient to seek health care (Gassaway, et al., 2017). 

According to a study by (Lin, Cheng, Shih, Chu, & Tjung, 2012), developing discharge 

plans for patients involves a number of processes. The first stage is the early identification 

and evaluation of patients, especially those required to be discharged from the hospital. 

The second stage involves the participation of the patient, family, and health care team to 

develop a discharge plan. The third stage is providing options, whether it is the locations 

of the parishioners or the health and medical services that are provided. The fourth stage 

is to communicate with agencies and care facilities in order to ensure that services reach 

the patient and close the gaps. The final stage is providing support and encouragement to 

patients and their families during the service. 



3 

1.2 Problem statement 

One of the most important things that has increased in the past two decades is the focus 

on determining patient safety and the continuity of his health after discharge from the 

hospital, and the success of this is linked to the implementation of safe discharge plans 

(Ellins, et al., 2012). 

There are many reasons for this, including the services or funding provided by the 

government and the diversity of the population structure, technological development, and 

drug treatments, all of which lead to older and more complex patients staying for shorter 

periods in the hospital. And they require ongoing health care management in the 

community. There are many motives that reduce the patient’s stay in the different 

departments, especially the acute ones. One of the motives was the technological 

development at all levels, and this was reflected in the surgical operations when compared 

to the old ones. There is a clear difference in terms of cost and health outcomes. Preparing 

the patient to leave the hospital is one of the main reasons. Nurses' tasks. Studies have 

shown that the faster the discharge planning, the better the patient's discharge process 

(Ellins, et al., 2012). 

One of the main reasons for the research on this subject is that hospital nursing encounters 

a number of challenges, such as a lack of understanding of the patient's hospital discharge 

strategy and even the degree of his involvement or role. Planning the discharge process 

demands certain characteristics and skills, as was mentioned. Nurses who meet the 

requirements for their position in the demobilization process must own it. Most countries 

in the world face this problem. An example of this is what the Health Care Commission 

in England worked on in 2007. He stated that out of 16,000 complaints between July 2004 

and July 2006, 5% of them related to developing a discharge plan for the patient in the 

hospital, and the most common thing among the complaints was poor coordination of 

services. Some complaints related to families not being notified before their relative was 

discharged from the hospital. Some of the complaints were the removal of weak patients, 

such as children and the elderly, the lack of consideration for support for weak patients, 

or the inappropriate time As shown in a study (Rib et al., 2007), In addition to the main 

reasons, there is a lack of studies in Palestine and the Arab world that look at the same 

goal, especially in Palestine. 



4 

There is no research explaining the mechanism of developing a discharge plan for patients 

or even the person responsible for planning the discharge of patients from the hospital—

is it the nurse, the doctor, or any person from the health care providers—and even the 

extent of implementation of the discharge plan mechanism, who is responsible for 

discharge planning in Palestinian hospitals, and even the skills that must be possessed by 

the person who sets the discharge plan mechanism. This led us to establish a study so that 

we could know the nurses' perception of the discharge planning process for adult patients 

in the acute medical care departments in Ramallah hospitals, which helps us determine 

who is responsible for discharge planning and what skills help the discharge planner in 

implementing the discharge plan and knowing the challenges that prevent the discharge 

plan from being implemented. However, in order to get rid of the dilemmas and for the 

discharge policy to succeed, it is necessary to understand the field in which the policy is 

applied and the positions, observations, and perceptions of the participants. It is stated in 

the policy documents that all registered nurses must be qualified in exit planning; 

obviously, patients require ongoing health care. 

Patients who are discharged from the hospital without adequate support are at risk of an 

adverse event or side effect on their condition at home, often leading to readmission to 

the hospital. 

1.3 The importance of the Study 

According to Abdel-Fattah and Meshkab (2017), over time, there were definite 

connections and linkages between patients' orientation toward community services 

following hospital discharge (from anyplace to care) and a discharge plan for the patient. 

As time went on, the phrase "discharge planning" started to be used more frequently since 

it encompassed both short- and long-term objectives, such as predicting changes in 

patients' demands during a short period of time, as well as long-term objectives, which 

refer to the continuity of care and provision of care for patients. Even after they stopped 

working for the acute departments, particularly the urgent ones. It may extend for weeks 

or months.  

The importance of the current study is to investigate the nurses' perception of the DP 

process for adult patients in the acute medical care departments in Ramallah hospitals, 

which helps us determine who is responsible for discharge planning and what skills help 



5 

the discharge planner in implementing the discharge plan and knowing the challenges that 

prevent the exit plan from being executed in an efficient and timely discharge. 

Furthermore, the vital adoption of the results and recommendations of this study will 

improve and activate discharge procedures in health care organizations to enhance the 

continuity of care in Palestine. 

1.4 Aim of the Study  

To investigate the nurses’ perception of the discharge planning process for adult patients 

in acute medical care departments in Ramallah hospitals. 

1.5 Study Objectives 

1. To identify the nurse’s perception of the patient’s discharge process at acute medical 

care departments in private and governmental hospitals in Ramallah city. 

2. To assess who should coordinate discharge planning at acute medical care departments 

in private and governmental hospitals in Ramallah city 

3. To assess nurses needed specific skills in an acute medical care department in private 

and governmental hospitals in Ramallah city 

4. To identify barriers to effective discharge planning at acute medical care departments 

in private and governmental hospitals in Ramallah city. 

5. To examine the relationship between the perceptions of nurses working in acute 

departments in Ramallah Hospital of the discharge planning process for adult patients 

and social and demographic variables 

6. To examine the relationship between the perceptions of nurses working in acute 

departments in Ramallah Hospital of the discharge planning process for adult patients 

in terms of coordination, management, and personal skill, discharge planning 

management, and barriers to conducting effective discharge planning. 

1.6 Questions of study 

1. What are the perceptions of the process of planning a patient’s discharge in acute 

departments in Ramallah hospitals? 

2. What are the barriers to effective discharge planning in acute departments in Ramallah 

hospitals? 



6 

3. What are the skills needed by nurses to carry out patient discharge planning in acute 

departments in Ramallah hospitals? 

4. Who is responsible for coordinating the patient's discharge planning in acute 

departments and the timing of discharge in Ramallah hospitals? 

1.7 Concepts and operational definition  

Before beginning the literature review, it is necessary to define the key terms related to 

the current study, such as discharge planning, adult patients, and acute medical care. 

Furthermore, we will talk about the contents of the socio-demographic characteristic 

profile related to the current study. 

Discharge Planning: Hospital discharge planning is a patient’s transition from one stage 

to another or from one level to another. Ideally, discharge plans are protocols that health 

care providers adhere to during a patient's transition from the hospital to home or a long-

term nursing home or facility (Cochrane, 2015). In our study, the researcher concentrated 

on the opinions of nurses who worked in acute departments on hospital patient discharge 

plans and provided responses to questions using the Likert scale (1: strongly disagree, 2: 

disagree, 3: neutral, 4: agree, 5: strongly agree). 

14 statements around nurses' perceptions of nurses working in acute departments about 

discharge planning for patients in the hospital for adult patients, It starts with questions 

1–14 in the second part of the questionnaire. 

Nurses: The nurse is one of the important personalities in the health care sector with 

different tasks, and these tasks pour into the goal of providing services to individuals, 

families, and communities. The goal is to achieve optimal health for patients and maintain 

and restore them. The difference between nurses and other health care providers can be 

seen through the practice, training, and patient care courses of nurses, which are part of 

most health care settings (Alharbi, Alanzi, Alenezi, & Alharbi, 2022). In our study, Using 

a Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree, 5: strongly agree), 

the researcher examined nurses' perceptions of the competencies required for patient 

discharge planning in acute departments. 



7 

10 statements around perceptions of the skills needed by the nurse to carry out patient 

discharge planning in acute departments, It starts with questions 1–4 in the first theme 

and questions 1–6 in the second theme in the fourth part of the questionnaire. 

Adult Patients: For any sick person who is 20 years old or older, the hospital considers 

this patient an adult patient, which means that services are provided until the patient is 

rehabilitated in the adult rehabilitation departments and he is not treated as a child; that 

is, he is placed in the names of the nationals for adults and the laws of adults apply to 

him. Pope et al. (2013) So that the researcher focuses on the nurses who work in the adult 

departments, the nurses will be asked several questions and answer accordingly to the 

Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree, 5: strongly agree). 

12 statements on how acute departments perceive the obstacles to efficient discharge 

planning, The fifth section of the questionnaire begins with questions (1-6) on the first 

theme, questions (1-2) on the second theme, and questions (1-4) on the third theme. 

Acute Medical Care: Hospitals that provide care, medical needs, psychological support 

for inpatients, and any other services for acute injuries or wounds. They are distinguished 

by the fact that the time period for these cases is clear when entering and discharge. 

(usually for a short-term illness or condition) (Fawaz, Anshasi, and Samaha, 2020). 

In order to gather data as quickly as possible, the researcher concentrated on the acute 

parts. For the patients who were in these sections, there were multiple questions with 

responses on a Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree, and 5: 

strongly agree). 

12 statements around perceptions of the barriers to effective discharge planning in acute 

departments, It starts with questions (1-6) on the first theme, questions (1-2) on the second 

theme, and questions (1-4) on the third theme in the fifth part of the questionnaire. 

1.8 Previous Studies and Theoretical Background 

There are several studies that have researched this topic and here is a summary of some 

of the studies on the global, regional and local levels. 

 



8 

 

1.8.1 Global Studies 

Lalani and Gulzar (2001) conducted a cross-sectional study for nurses working in four 

medical-surgical units in Pakistan The purpose of the study was to determine the extent 

of nurses’ knowledge in terms of their role, behavior, and actual treatment toward DP in 

acute departments and for patients admitted to those departments. The study participants 

were 15 nurses, 15 patients, and 15 files. One of the most notable findings was that the 

nurses had no knowledge regarding the physician's influence on their DP practice. After 

researching the results of that study, 20% of the nurses were aware of their role in the 

matter. 67% of the nurses working in acute departments and working with critically ill 

patients said that discharge planning is only prepared on the day of the patient’s discharge, 

and as for preparing for patients’ discharge, only 2% of the time. Nurses were assigned 

part of their total work during an 8-hour shift. 

(Chaboyer, Foster, Kendall, & James, 2002) conducted a cross-sectional study in 

Australia to examine nurses' perceptions in the intensive care unit (ICU) about their tasks 

or role in patient discharge planning. The instrument used in this study consisted of 

several sections and included demographic questions. In the first section, a focus group 

was held with ICU nurses, and the results of Schlemmer's (1989) qualitative research 

were used to devise 140-item visualizations of the Discharge Planning Scale (PDPS). The 

sample for the study was 65 nurses from the intensive care unit. The results were as 

follows: 70% of them considered discharge planning an essential and valuable priority in 

the intensive care unit. In contrast, 40% of them found that they lacked knowledge of 

discharge planning This means that the nurse is responsible for providing discharge 

information to the patient and believes that the other half is the work of the physician 

responsible for providing the patient with a discharge plan. 

Atwal (2002) conducted a case study. The study sample consisted of 19 nurses, knowing 

that the participants in the study were from several different departments distributed over 

surgery, orthopedics, etc. And it was clear that the nurses are in constant contact with 

other health care providers in order to prepare and start coordinating the discharge of the 

patient, and one of the most prominent results is that one The main barriers to discharge 

planning are how patients are delivered or even communication between nurses. Time 

https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.547#nop2547-bib-0015


9 

constraints were the most significant constraint affecting interprofessional work and 

hence the coordination of assessments. 

(Anderson, Deepak, Amoateng‐Adjepong, & Zarich, 2005) conducted an interventional 

study in the USA under the title Benefits of comprehensive inpatient education and 

discharge planning combined with outpatient support in elderly patients with congestive 

heart failure. The study sample consisted of 276 people with a primary diagnosis of 

congestive heart failure during the study period, 126 failed to meet the inclusion criteria, 

and the education nurse randomly examined 60 patients. Fifty-six subjects agreed to enrol 

in the heart failure program. Twelve patients were referred to outpatient home health care 

agencies who were not involved in the outpatient clinical course of congestive heart 

failure described and were therefore excluded from the analysis. The intervention cohort 

comprised the remaining 44 patients who completed the entire inpatient and outpatient 

CHF protocol. For the intervention patients, demographic and clinical information was 

obtained during the face-to-face session with the cardiac nurse educator. The home health 

care nurses ascertained six-month prospective readmission rates from patient interviews. 

A comprehensive intervention in terms of complete patient information prior to discharge 

significantly reduced the 6-month readmission rates from 44.2% to 11.4%. In the study, 

several results were obtained, including that giving instructions to patients with heart 

failure before discharge and setting a plan for them had results that reduced the return of 

patients to the hospital. Even these patients obtained higher degrees of readiness for 

discharge. 

A study by (Watts & Gardner, 2005) aimed to collect information about the extent of 

nurses’ knowledge of DP. Twelve nurses working in the acute care units of Hong Kong 

Hospital in Japan served as the target sample for the interview, which was conducted. The 

study's findings caught our interest because 75% of nurses believe that their relationships 

with other healthcare professionals serve as the foundation for their job, communication, 

and assessment. As a result, either the nurse is focusing on the achievement of the 

discharge plan or she is not doing her job well. This suggests that one of the traits of the 

individual who organizes discharge arrangements is excellent communication. 

A qualitative study titled Barriers to Effective Discharge Planning was carried out by 

Wong et al. in 2007. "Wong et al." It should be noted that the study focused on a number 



10 

of healthcare professionals who are crucial in creating discharge plans for patients in the 

care divisions of hospitals in Germany. The study's goals were to identify the approaches 

taken in discharge planning, the approaches that make the discharge plan effective, the 

challenges that hamper effective discharge planning, and the systems and ideas that would 

develop hospital discharge planning. In hospitals, semi-structured group discussions were 

used to gather the data. Information was collected over a time period of 90–120 minutes, 

and the procedures were audiotaped with the consent of the participants. And who 

collected information during a discussion with participants from medical backgrounds 

and senior researchers on the team? Where the population was linked to the participants, 

including age, gender, and work experience The number of participants in the study was 

41 healthcare professionals and was as follows: 9 doctors, 13 nurses, 6 occupational 

therapists, 5 physical therapists, and finally 8 specialists in social medicine. The ages of 

the participants, who were primarily female, ranged from 30 to 59. The various real-world 

encounters each of them has had One of the most striking findings was the widespread 

consensus among healthcare professionals that a consistent, policy-based process was 

essential for efficient discharge planning. The panelists emphasized that there are 

numerous social and cultural barriers to adopting the discharge strategy and that nurses 

are most important in doing so. The majority of the participants shared this viewpoint.  

(Boughton & Halliday, 2009) conducted a qualitative study by interviewing 14 caregivers 

and patients. The patient's description of the anxiety brought on by ignorance and their 

capacity to handle issues with self-care that influenced their desire to return home were 

the main focus of the interview questions. According to the findings, keeping the patient 

in the hospital is safer. Interview data was gathered. There were 17 perceived causes for 

recurrent hospital admissions, but the most common one for patients to return was a lack 

of knowledge on what to do after being discharged. 

Shepperd et al. (2009) conducted a descriptive study titled Early Discharge Hospital at 

Home in Australia. We contacted the investigators of 21 included trials (total number of 

participants = 2872) by email or telephone, inviting them to contribute data to the 

hospital-at-home early discharge collaborative review. The study included twenty-six 

trials; the number of participants was 3967, and 13 of the 21 trials contributed to data 

collection, i.e., 66%. The study's findings demonstrated that early discharge to the 

patient's home boosted patient satisfaction. It stated that once the patient was discharged 



11 

from the hospital, side effects were lessened thanks to patient satisfaction and the 

effective use of discharge planning measures. Patients were questioned regarding the 

benefits and drawbacks of their care in order to statistically summarize the study. The 

majority of patients felt that they would benefit more from an early discharge than those 

who remained in the hospital (difference 13.8%; 95% CI 5% to 23%, P0.01). 

A descriptive study titled Patient Satisfaction was carried out by (Prakash, 2010) in the 

dermatology department of the Vydehi Hospital in India. According to the findings, 

patient satisfaction is dependent on establishing a clear exit strategy and assisting the 

patient even after he leaves the hospital. This decreases the likelihood that the patient will 

need to return and even lowers the expense of the side effects. Within a month of 

gathering the sample, 150 surgery patients were included in the sample, and 70% of them 

agreed with the nurse who had previously explained the exit strategy to them. 

Shepperd et al. (2010) conducted a systematic review under the title Discharge Planning 

from Hospital to Home. Where the sample was chosen, which is all patients in the hospital 

(acute, rehabilitation, or community), regardless of age, gender, or condition, and the 

intervention that took place in the study was the discharge planning process, it is divided 

according to the steps specified by Marks (Marks 1994): a) Pre-admission evaluation (if 

applicable). b) Case discovery on admission c) Inpatient assessment and preparation of a 

discharge plan based on the individual patient's needs, e.g., a multidisciplinary assessment 

involving the patient and his family and communication between the professionals 

involved within the hospital. Implementation of the discharge plan This should be 

consistent with evaluation and require documented discharge in practice. e) monitoring, 

Twenty-one RCTs (involving 7234 patients) are included; ten of these were identified in 

this update. Fourteen trials recruited patients with a medical condition (4509 patients); 

four recruited patients with a mix of medical and surgical conditions (2225 patients); one 

recruited patients from a psychiatric hospital (343 patients); one recruited patients from 

both a psychiatric hospital and a general hospital (97 patients); and the final trial recruited 

patients admitted to the hospital following a fall (60 patients). Hospital length of stay and 

readmissions to the hospital were significantly reduced for patients allocated to discharge 

planning. This was also the case for trials recruiting patients recovering from surgery with 

a mix of medical and surgical conditions. In three trials, patients assigned to discharge 



12 

planning reported increased satisfaction. There was little evidence of overall healthcare 

costs. 

Wills et al. (2012) conducted a random study in which participants were randomly 

selected in a local health district in Western Sydney (Westmead Campus) under the title 

of the plan for occupational treatment discharge for the elderly. 400 participants were 

recruited from participating hospitals; their age was 20 years and over. One of their 

characteristics was that they did not have significant cognitive impairment and were 

mobile independently when discharged. The participants were randomly assigned to the 

intervention group or the control group. One group was given an intervention, which is 

an intervention in discharge planning within their home environment, while the second 

group was given an in-hospital consultation without an intervention at home, both 

provided by trained occupational therapists. This study concludes that there is a 

significant gap in current exit planning and occupational therapy practice. A best practice 

planning program will be developed not only in terms of its effectiveness but also its cost-

effectiveness, because it was clear from the results that the first group that was given a 

discharge plan decreased the rate of return to the hospital from 70% to 10% compared to 

the group that was limited to the discharge plan in the hospital. 

Morris (2012) Conducted a cross-sectional study in the Faculty of Health, Plymouth 

University, Truro, England, on the perceptions of nurses involved in writing or creating 

the discharge planning process for adult patients. The survey included 461 registered 

nurses working in acute departments, that is, the clinical areas where the majority of 

patients leave for home. The questionnaire consists of 10 statements concerned with self-

efficacy for awareness of exit planning, and the Schwarzer and Jerusalem scale used by 

Schabauer was used. The questions consisted of four open-ended questions about 

perceptions, skills, and even obstacles that prevent effective exit planning. There are nine 

questions concerned with personal characteristics and the employee’s workplace. Where 

the response rate among nurses was 30%, which means that 137 questionnaires were 

completed out of 461 questionnaires that were sent by mail, and where the most prominent 

results were about the respondents' perceptions of the demobilization planning process 

Loneliness was believed by 76% of the respondents: One of the notable results was that 

planning the discharge of patients from the hospital is the responsibility of the bedside 



13 

nurse. 59% of the participants agreed that planning the discharge of patients should be 

the responsibility of the bedside nurse. 

(Dotson & Lewis, 2013) explored the results of a project carried out in 2013 by senior 

nursing students and geriatrics colleagues working jointly to improve on-site quality in a 

long-term care environment. The study concluded that the nursing students' involvement 

helped improve their roles in all disciplines, including patient discharge planning. 

In Isfahan, Iran, Barakatin et al. (2013) conducted a cross-sectional study with the aim of 

identifying the factors that cause patients to visit the hospital again or admit new patients. 

3935 patients were the subject of the investigation. Information was gleaned from medical 

papers or records. The study lasted for almost 6 years. The Nour Hospital at Isfahan 

University saw patients complaining of a variety of distinct and acute ailments between 

the years of 2004 and 2010, it was noted. One of the standout findings was that when a 

discharge plan was created, it helped to reduce the patients' need for hospital readmission 

(p value = 0.024). 

(Graham, Gallagher, & Bothe, 2013) conducted a descriptive study in Italy examining 

nurses' discharge planning understanding, adherence, and barriers. The study was based 

on two research questions: How is the nurses' experience of continuity during the 

transition of older patient care from hospital to municipal health care? How do nurses 

describe the optimal transition of care? This highlights the role of nurses during the 

transition of patients from the care center to their homes. The number of participating 

nurses was = 30, working in hospitals (n = 16) and municipalities (n = 14) in five mixed 

focus groups from October to January 2014/2015. Focus groups met twice. Outcome 

adherence to the discharge planning policy was low (23%), despite general awareness of 

the low quality of patient outcomes that may result. Time constraints and patient factors 

were the most common barriers to specific discharge planning. One of the most important 

conclusions of the study was that patients needed additional support to implement the 

discharge planning policy. 

(Wales, et al., 2012) Several different levels were found in terms of patient participation 

in discharge planning, and when compared with a study reported in other studies (Garratt, 

2009), it was higher than. When the annual patient satisfaction survey was collected in 

2015 in the United Kingdom, (84%) reported their participation in planning. For their 



14 

discharge from the hospital, the results indicate that two-thirds of patients received 

printed information about their care when moving home. 

These findings demonstrated that large proportions of patients and family members are 

not fully involved in hospital discharge planning or receiving information about their 

caregivers at home. 

(Chang, et al., 2015) conducted a qualitative study via an interview in The purpose of the 

study was to prepare discharge planning for patients in a Taiwanese emergency 

department. The study targeted 25 participants in completing the questionnaire. One of 

the most prominent findings in this study and what drew attention are the factors that 

affect the preparation and effectiveness of the DP: first, neglecting or not giving the nurse 

the right to act in the emergency department; Giving the nurse more work than he can 

handle, meaning he does not have time to develop or prepare a discharge plan. Behavior 

in a negative manner on the part of the patient’s relatives towards nursing, which weakens 

the development of the discharge plan, and the most important factor that affects the 

effectiveness of discharge planning is the patient’s poor morals or the nurses’ poor morals 

by not respecting the doctor’s decisions. 

 (Daniela, et al., 2016) and (Gonçalves-Bradley, Lannin, Clemson, Cameron, & 

Shepperd, 2016) conducted a semi-qualitative, The research targeted several categories 

of patients: the elderly patients section, the second section, patients who were discharged 

from surgery departments after receiving treatment, and the third and final section, which 

includes several diverse cases. The number of participants in filling out the questionnaire 

was approximately 11,964 nurses, and the purpose of the study was to determine the 

extent of the participants’ knowledge in preparing or preparing a discharge plan. One of 

the most prominent results that emerged is that developing or preparing a discharge plan 

reduces the length of the patient’s stay in the hospital. Effective hospital discharge 

planning increases the level of satisfaction among study participants and reduces the 

budget set by the hospital to provide health services. 

Rahayu et al. (2016) A literature review was done by collecting the results of scientific 

publications from 2011–2016 from databases in Indonesia to review coaching in nursing 

to improve the quality of discharge planning. Among the most prominent results was that 

discharge planning is part of nursing care. The nurse has a major role in developing the 



15 

discharge plan, and the nursing manager has a significant role in training nurses to 

develop an exit plan. Unfortunately, the majority of managers still lack the ability to train 

nurses. 

Gabrie et al. (2017) conducted a systematic review in a hospital in Dublin, Ireland, Data 

and information related to the effectiveness of exit planning were collected. After 

reviewing the references in the past ten years, the previous references recommended the 

role of discharge planning in reducing the cost for patients, the patient’s stay overnight, 

and the best health outcomes for the patient, which reduced the readmission of patients 

to the hospital. 

At RSUD Pringsewu Hospital in 2018, Albaar (2018) carried out a cross-sectional study 

to ascertain the association between knowledge techniques and "nurses'" compliance in 

discharge planning. The sample is composed of 28 individuals. Both univariate and 

bivariate analyses were performed in the study. The results show a strong correlation 

between nurses' knowledge and compliance in nursing. Planning your discharge from 

Bringsaw District Hospital: It was evident that nurses' knowledge of discharge planning 

was relevant to improving nursing care services. Take note that 75% of responders had 

nursing degrees, and the majority were adults. A person's education is just one of many 

traits that can influence their knowledge. 

Tobiano et al. (2019) conducted a descriptive study in a Swedish university hospital, The 

purpose of the study was to show the participants’ experiences in preparing discharge for 

patients in departments that provide care, especially acute ones. The number of 

participants in the study was 15 nurses. One of the most notable results of the research is 

that there is a strong relationship between discharge planning and reducing the rate of 

patients returning to the hospital, meaning when Discharge plans were given. The rate of 

the patient returning to the hospital decreased from 80 percent to 30 percent. It also 

appeared that the accommodation costs for patients increased when a discharge plan was 

not given due to their frequent return to the hospital, given that the research was a 

descriptive study. 

A descriptive study was conducted by (Steils, Woolham, Fisk, Porteus, & Forsyth, 2021). 

This study examined who in Minnesota hospitals is primarily in charge of discharge 



16 

planning. The sample included all 136 Minnesota acute care hospitals that were accredited, 

two Veterans Administration hospitals, and had a sample size of 130. Based on 

quantitative assessments, it was determined that nurses and social workers were primarily 

involved in the role of discharge planning in Minnesota's tiny rural hospitals, which serve 

the majority of the state's patients. Compared to social workers, hospital nurses were more 

likely to be in charge of discharge planning. 

(Muhamad, et al.) conducted a qualitative case study in Kelantan with the aim of 

gathering perspectives from staff and patients regarding the discharge procedure. 150 

nurses who worked in acute departments like surgery and orthopedics were included in 

the sample. According to the findings, 69% of respondents believe that the discharge 

process has gotten more organized as a result of several techniques that include stating 

the anticipated discharge date and making it clear in patient rooms and post-discharge 

duties. 

Reig-Garcia et al. (2022) conducted quantitative research in Spain with the The purpose 

of the study was to collect nurses’ knowledge of the discharge plan in different parish 

departments. The study targeted 31 hospitals, and the number of participants in the study 

was about 600 people in Spanish hospitals. The most prominent results of this research 

were that 60% of the hospital nurses participating in the study said that the responsibility 

for planning discharge falls on the nurse responsible for the patient. As shown, the more 

experience a person has, the greater his ability to plan discharge in a better way. There is 

also a relationship between those who have higher education (82.6%, P < 0.05) or a PhD 

(72%, P < 0.05). 

A descriptive study was conducted in the state of Queensland, Australia, by (Kang, 

Tobiano, Chaboyer, & Gillespie, 2020). The goal of the study was to ascertain if the nurse 

provides patients with enough information when they leave the hospital or if she omits to 

do so. You should be aware that the study's objective was the surgery department from 

April to December 2016, and the sample of participating nurses' experience ranged from 

one year to 38 years in care departments. Interviews were conducted with 12 women and 

39 men, with 29 participants having doctoral degrees. The participants' average age was 

It is 38.51 years old, and individuals have an average of 10.12 years of work experience. 



17 

It was clear that nursing and health care management were involved in preparing and 

monitoring discharge planning for patients. 

A cross-sectional study titled Evaluation and Perceptions of a Nursing Discharge Plan 

among Nurses from Different Healthcare Settings was conducted in Spain by (Reig-

Garcia, Bonmatí-Tomàs, & Suñer-Soler, 2022). The study was unique in that it focused 

on 21 healthcare facilities, and the researcher utilized a mixed strategy with an 

explanatory sequential design. The study participants' age, gender, number of years of 

professional experience, and present employment were the main topics of the first section 

of the questionnaire employed by the researcher. The second portion of the questionnaire 

asks about the nurses who took part in the study's perceptions of discharge planning. 

There are 4 questions in this section designed to gather data about participants' 

perceptions of discharge planning. The fact that 66.1% of the study's participating nurses 

agreed with the importance of implementing the discharge plan, that full-time employees 

were strongly associated with doing so (69.9%, p 0.05), and that employee co-location 

was significantly associated with exit plan implementation (97.2%, p 0.00) are among the 

most notable findings. 

1.8.2 Regional Studies 

The purpose of Daniela, Gonsalves, and Gonsalves Bradley et al.'s (2016) descriptive 

study was to evaluate the efficacy of discharge planning for emergency visits. The study 

focused on 173 nurses employed by King Abdulaziz Medical Hospital in Riyadh's 

emergency and acute care units. Naturally, individuals who had previously been admitted 

to and released from the emergency department were excluded after gaining the 

agreement of all study participants. The study's most notable findings were that sharing 

discharge information with caregivers in writing or verbally is the most efficient way to 

do it. The majority of participants (64.16%) and those who were unable to identify the 

issues that needed follow-up (58.96%) did not have any knowledge of the discharge plan. 

More care must be taken when disseminating information for the discharge plan because, 

according to the report, 34.68% of patients leave the hospital without receiving discharge 

instructions. 

A semi-qualitative study that was conducted in the Arab country of Iraq by Mohammed 

et al. (2016) showed that there is a relationship between the number of years of experience 



18 

with the disease and the recovery of patients and positive results on their health, so that 

the greater the experience, the stronger the relationship. When reviewing the most 

prominent results of the study, we noticed that the exit plan was implemented effectively 

and enthusiastically among recent graduates and males. 

(Hayajneh, Hweidi, & Abu Dieh, 2020) conducted a thorough analysis of the nurses' 

understanding, opinions, and actions on discharge planning in acute care settings. The 

perceptions and behaviors of nurses about discharge planning in acute departments were 

the subject of three studies. It should be noted that the requirements cover nurses' 

knowledge and skills. the DP's implementation in terms of attitudes, practices, behaviors, 

or beliefs; What prevents planning from being successful or effective the most? The study 

has 178 nurses as participants. One of the most interesting results was that, among all 

management responsibilities, those who identify and are accountable for being nurse 

managers have a reasonably high priority (a score of 7.29 out of 10 possibilities), which 

represented nearly 70% of the participants.  

1.8.3 Local studies 

From studies conducted by (Auslander, Soskolne, Stanger, Ben-Shahar, & Kaplan, 2008). 

The aim of the study was to find ways to implement discharge planning and discharge 

outcomes for patients in an effective manner. The study targeted 1426 adult patients 

admitted to 11 hospitals in Israel, which occupies the Palestinian territories. The nurses 

working in the nursing departments gave coordinated and programmed discharge plans 

to the patients, and after two weeks, the patients were followed up at home by telephone. 

The results showed that 40% of patients were transferred to institutional care, and 60% 

were transferred to homes that have plans to receive community services. The results, 

most notably the study, showed that the rate of patients returning to the hospital is low, 

and this is due to discharge plans. 

(El-Abbassy, et al., 2021) conducted a quasi-experimental research design. The title and 

focus of the study were on the impact of the discharge plan on patients undergoing 

transhepatic arterial chemoembolization. The study was at the Center for Interventional 

Radiology and Surgical Catheterization at Zagazig University Hospital. The study 

targeted 70 nurses of both genders. Information was collected from them. After the results 

appeared, what caught attention was that 41.4% of the participants were male, and the 



19 

ages were between 20 and 60 years. It was noted that the return to the hospital decreased 

from 70% to 10% when implementing a discharge plan for the participants in the study, 

and it was very clear that the effects of developing the discharge plan increased. 

1.9 Summary 

In this section, the researcher presented the available studies that supported the study 

method used. The opposite has been demonstrated. After presenting the studies and 

reviewing all the previous studies, it was proven that there is a lack of research on this 

topic in general, and its lack is almost reaching the point of lack of research on this topic 

in Palestine in particular. When the studies were followed up over several years, one of 

the most significant findings was that the majority felt that it was the nurses' job to carry 

out the discharge plan and that one of the biggest challenges to doing so was inadequate 

communication. There is a literature summary table in the appendix. 

 

 

 



20 

Chapter Two 

The Method 

 This section clearly outlines the research approach used in this study. In addition, it 

clearly defines how important data and information are handled. 

2.1 Study design 

A descriptive and quantitative cross-sectional design is adopted to assess the nurses’ 

perception of the discharge planning process for adult patients in acute medical care 

departments in Ramallah hospitals. 

2.2 Study setting  

The study was performed in  five hospitals in Palestine, governmental and private, 

andthey are as follows: 

• Arab Care Hospital. 

• Medical Complex. 

• Future Hospital. 

• Red Crescent Hospital. 

• H- clinic hospital. 

2.3 Study population  

This study was conducted by selecting a purposive sample of all the nurses who worked 

in an acute department from Mid –October to the end of December 2022. 

2.4 Study Sample 

The researcher used a purposive non-probability sampling technique for this cross-

sectional study by recruiting all the accessible nurses who worked in acute medical care 

departments. Purposive sampling is more readily accessible and more convenient, and it 

selects only those individuals that are relevant to the research design. The program that 

was used to calculate the sample is: https://www.raosoft.com/samplesize.html. Therefore, 

the total number of distributed questionnaires was 400. The returned questionnaires were 

distributed as follows: 160 of the 200 questionnaires came from the Medical Complex, 

63 of the 80 questionnaires came from the Red Crescent Hospital, 13 of the 30 



21 

questionnaires came from the Future Hospital, 23 of the 40 questionnaires came from the 

Arab Hospital, and 41 of the 50 questionnaires came from the H Clinic Hospital. 

2.5 Study time frame 

The study was conducted between mid-October 2022 and the end of February 2023. This 

study took place in the acute medical care departments of Ramallah hospitals. 

2.6 Data collection tool 

The study we have in hand used a modified version of the discharge planning 

questionnaire developed by Chabuer et al. (2002), adopted by (Morris, 2012), and 

applied  to acute section nurses whose content validity has been determined. The 

questionnaire has been modified, and questions have been developed according to the 

environment and the target individuals, who are registered nurses working in all clinical 

specialties. Content accuracy has been re-checked by an academic nurse at An-Najah 

National University. The questionnaire used in the research is composed of two parts. 

The first part of the questionnaire introduced the participants' demographic features (age, 

gender, place of work, years worked as a nurse, position, years working in their current 

position, nature of work, and number of discharges initiated per week). The second part 

of the questionnaire included perceptions about the DP process, including who should 

coordinate discharge planning and the discharge timing, specific skills nurses need to 

carry out DP , and barriers that prevent effective DP. The questionnaire has been 

translated into Arabic, adapted, and validated for implementation. See sections 1 and 2 

attached below for clarifications: 

Section 1: The first part of the questionnaire introduced the demographic features of the 

participants: 

Section 2: Perceptions around the DP among the nurses. 

Section 3: Who should coordinate discharge planning and the timing of discharge? 

Section 4: Nurses need specific skills to carry out discharge planning. 

Section 5: Barriers to conducting effective discharge planning. 

A Likert-type scale was used to assume that the strength or intensity of the experience is 

linear, i.e., on a continuum from strongly disagreeing to strongly agreeing. Respondents 



22 

were offered a choice of one to five responses, with the neutral point being neither agree 

nor disagree, whereby one refers to strongly disagree, two refers to disagree, three refers 

to neutral, four refers to agree, and finally, five refers to strongly agree, as shown in the 

table below by (Steils, Woolham, Fisk, Porteus, & Forsyth, 2021). 

Table 2.1  

5 Points Likert Scale Table 

Likert scale Interval Difference Description 

1 1.00-1.79 0.79 Strongly disagree 

2 1.80-2.59 0.79 Disagree 

3 2.60-3.39 0.79 Neutral 

4 3.40-4.19 0.79 Agree 

5 4.20-5.00 0.80 Strongly agree 

Reference: Sullivan et al. (2013). 

2.7 Validity and Reliability of the Questionnaire  

The reliability of the study tool was examined by two groups. The first group was made 

up of numerous nurses who had been practicing for more than 15 years and who also held 

master's and PhD degrees in nursing. They came from Al-Arabi Specialist Hospital and 

An-Najah Hospital. The nursing director and department head for intensive care is a nurse 

from An-Najah Hospital. The nurse practitioner from Al-Arabi Hospital served as the 

emergency department's director. Two academics with PhDs made up the second team 

that attempted to restore the legitimacy of the study instrument. While the other served as 

a professor at An-Najah University, the former served as dean of the Nightingale College 

of Nursing. The recommendations were taken in order to improve the quality. This can 

be found by referring to Appendix A. 

Reliability 

A pilot study was performed for 43 nurses from the target population excluded from the 

sample size to check the validity, internal consistency, and reliability of the questionnaire 

adapted and adopted in the current study using Cronbach's alpha correlation coefficients. 

The pilot study was conducted after obtaining approval from the participants. Information 

in terms of the study in general and the objectives of the study in particular was given to 

the participants voluntarily, and a consent form was signed. Earlier, before adopting the 



23 

questionnaire, the researcher conducted a pilot study and observed the results. This gave 

an indication that the questionnaire was clear to the participant and easy to understand for 

all participants. It also gave a good interpretation of the data and fewer participants’ errors. 

Table 2.2: When viewing the results of the table, it displays reliability coefficients for 

various fields. Cronbach's alpha value was 0.801 for the extent of knowledge of the exit 

planning process. 0.626 relates to identifying who plays a role in planning, preparing for, 

or coordinating the exit; 0.942 relates to the skills that the person attending the exit 

planning must possess; and 0.875 relates to obstacles that prevent effective DP. 

Table 2.2 

Reliability coefficients for the various domains 

Variable No of Items Cronbach's Alpha 

perception about the process of planning a patient’s 

discharge in acute departments. 
15 0.801 

Responsible party for preparing patient discharge 

planning and timing. 
14 0.626 

perception of the skills needed by the nurse to carry out 

patient discharge planning in acute departments. 
6 0.942 

perception of the barriers to effective discharge planning 

in acute departments. 
8 0.875 

Note: Alpha Cronbach's value 0.01-0.60: unacceptable, 0.61-0.70: acceptable 0.71-0.80: acceptable and 

good , 0.81-0.90: good, 0.91-1.00: excellent. 



24 

2.8 Study procedures 

Figuer 1 

Sudy procedures  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May 9, 2022 

Initially, a research proposal for the current study was prepared, and 

the study tool (a questionnaire) was presented to the experts and a 

group of arbitrators before being submitted. 

Official approvals were obtained from the Faculty of Graduate 

Studies and IRB at A-Najah National University and from official 

authorities to facilitate carrying out the field study by distributing 

questionnaires to collect data; see appendices (A and B). 

between 

October 2022 

and the end of 

February 2023 

interpreting and discussing results and formulating 

recommendations, proposals, and conclusions. 

The study tool was applied to the study sample, and the data was 

collected, analyzed, and converted into information through 

special tables . 

A pilot study was conducted to ensure the validity and reliability 

of the study tool. 

A review of previous studies and theoretical frameworks in the 

field of research to build the theoretical framework for the current 

study has been published. 

October 10, 

2022 

between 

November 3, 

2021, and January 

17, 2022. 

between 

October 2022 

and the end of 

February 

2023 

Finally 



25 

2.9 Data Analysis  

The researcher reviewed the questionnaire in all its details and checked for completeness 

and consistency. The information was processed, given codes, entered into the system, 

cleaned, interpreted, and analyzed. Using the Statistical Package for the Social Sciences 

(SPSS V26.0), The data were entered and double-checked for outliers or errors. 

Kolmogorov-Smirnov and Shapiro-Wilk tests for non-normality were used. Kolmogorov-

Smirnov and Shapiro-Wilk tests (Table 2.3) revealed that all domains were not normally 

distributed with P < 0.05. 

To represent the frequency and percentages of the questionnaire or variables, the 

researcher used descriptive analysis, as well as the personal and social characteristics of 

the respondents. Descriptive analysis was used to represent them. The strength of the 

relationship was measured. Using the odds ratio at a 95 percent confidence interval and 

P values of 0.05, significant relationships exist. 

2.10 Ethical considerations 

Ethical considerations were taken into account in the study through postgraduate approval 

(dated 04/22/2022). Appendix A. Ethical approval was obtained from the Institutional 

Review Board ("IRB") at An-Najah National University in Nablus, Palestine (dated May 

9, 2022). Appendix (B) and official books obtained by postgraduate studies were 

distributed to each of the following governmental and private hospitals, which are as 

follows: (Arab Care Hospital, Medical Complex, Future Hospital, Red Crescent Hospital, 

HI Clinic Hospital) The purpose of the books was to obtain permission to distribute the 

questionnaire and information sheet. Approval was obtained for the questionnaire in 

English and Arabic. Filling out the questionnaire and participating was by the person’s 

choice and not for rent, i.e., voluntary, as shown in Appendices (D, E, F, F). Information 

about the purpose of this study was provided to participants. The focus was on privacy 

throughout, and therefore the right to withdraw from the study at any time was allowed 

without consequences. They were also informed that they could withdraw from the study 

at any time without any penalty, and serial numbers were also used to collect and save 

the questionnaire. 

 



26 

2.11 Inclusion and exclusion criteria 

Inclusion Criteria 

• Nurses working in selected hospitals. 

• Nurse working in acute wards. 

• Nurse being able to give informed consent. 

Exclusion Criteria 

• Caregivers in the hospital except for nurses.  

• Nurses work in operation rooms and chronic wards. 

• Eligible participants unwilling to give consent 

2.12 Study variables 

The research study will include the following variables: 

A. Independent variables 

Nurses perception about the process of planning a patient’s discharge in acute 

departments. 

B. Dependent variables 

1. Perception related to the parties responsible for coordinating the patient's discharge 

planning in acute departments and the timing. 

2. Perception of the skills needed by the nurse to carry out patient discharge planning in 

acute departments. 

3. Perception of the barriers to effective discharge planning in acute departments. 

 

 

 

 



27 

Figure 2 

Study variables 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nurses perception 

about the process of 

planning a patient’s 

discharge in acute 

departments 

perception related to the parties 

responsible for coordinating the 

patient's discharge planning in acute 

departments and the timing. 

perception of the skills needed by 

the nurse to carry out patient 

discharge planning in acute 

departments . 

perception of the barriers to 

effective discharge planning in 

acute departments 

 



28 

Chapter Three  

 Results 

The present study included 300 nurses from governmental and private hospitals in 

Ramallah. In this section of the study, the collected data then tabulated, analyzed, and 

then interpreted individually using statistical programs and tests. Below, this section 

begins with the characteristics of those studied 

3.1 Demographic characteristics of the nurses 

The response rate among nurses reached 75%. In other words, 400 questionnaires were 

distributed to the participants, and 300 of them were filled out and returned. As for the 

characteristics of the nurses participating in the study, the results showed that their 

percentage was nearly equal concerning gender, while the majority were aged between 

20 and 29 years (53.3%) and worked in the governmantal hospital. Also, most study 

participants are registered nurses (61.7%), as well as full-time employees (83.3%) and 

(54.3%) with experience of 5 years or less as shown in the table below. 

Table 3.1 

Demographic characteristics of the nurses  

Demographic characteristics of the nurses Frequency Percent)%( 
 
Gender  

Male 152 50.7 

Female 148 49.3 

Age 

20-29 years 195 65 

30-39 years 75 25 

40-49 years 27 9 

50-60 years 3 1 

Work place 
governmantal 160 53.3 

non-governmantal 140 46.7 

Job description 

Assistant nurse 28 9.3 

Practical nurse  69 23 

Registered nurse 185 61.7 

Head nurse  11 3.7 

Other  7 2.3 

Nature of work 
Full time 250 83.3 

Part time 50 16.7 

Experience years 

5 years or less  163 54.3 

6-11 years  91 30.3 

12-19 years  39 13 

20 years and more 7 2.3 



29 

3.2 Numbers of dscharges per week 

The average number of discharges by outcome is 16.04 cases per week, with a wide range 

from 1 to 60 cases. (see table 3.2). 

Table 3.2 
Number of discharges per week 

Number of discharges per week 
Mean Standard deviation Min Max 

16.04 10.48 1 60 

 

3.3 Nurses' perceptions of the DP process 

When looking at the results presented in Table 3.3 below, we note that the overall mean 

score for perceptions of the DP process among nurses is M = 3.19. This means that 63.8% 

of nurses have perceptions about discharge planning. The results show that 68% of nurses 

agreed that the nurse monitoring the patient is the one who attends to, supervises, or 

whose job falls on discharge planning; the remaining 20.3% of participating nurses 

disagreed, and results illustrate that 76.3% of participants agree or strongly agree on the 

question (discharge planning and adequate guidance are given to patients by doctors), 

56.3% of participants agree or strongly agree on the question (lack or decrease in 

information among participants regarding the concept of how to prepare for DP), and 

72.4% of participants agree or strongly agree on the question (discharge planning is 

useful). In addition, results pointed out that 67.6% of participants agreed or strongly 

agreed on the question (discharge planning is beneficial for the patients), 72.4% agreed 

or strongly agreed on the question (discharge planning is useful), and 60.9% agreed or 

strongly agreed on the question (discharge planning is time-consuming). The mean score 

in discharge planning is useful with M = 3.92, SD = 0.96, and when I looked at the mean 

for discharge planning as not a priority, M = 3.48, SD = 1.23.



30 

Table 3.3 

Perceptions of the DP process among nurses 

Question 
Strongly 

disagreed 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

Discharge planning is the responsibility of the bedside nurse 
18 

(6%) 

43 

(14.3%) 

35 

(11.7%) 

102 

(34%) 

102 

(34%) 
3.75 1.23 

Doctors provide enough direction for nurses to plan discharge planning 
6 

(2%) 

32 

(10.7%) 

33 

(11%) 

135 

(45%) 

94 

(31.3%) 
3.93 1.01 

Nurses in general have a lack of understanding of the discharge planning process 
23 

(7.7%) 

42 

(14%) 

57 

(19%) 

100 

(33.3%) 

78 

(26%) 
3.56 1.22 

Patients are fully involved in the discharge planning process 
8 

(2.7%) 

37 

(12.3%) 

62 

(20.7%) 

116 

(38.7%) 

77 

(25.7%) 
3.72 1.06 

Discharge planning is useful 
6 

(2%) 

19 

(6.3%) 

58 

(19.3%) 

125 

(41.7%) 
92 (30.7%) 3.92 0.96 

Discharge planning is time consuming 
9 

(3%) 

40 

(13.4%) 

69 

(23%) 

109 

(36.3%) 

73 

(24.3%) 
3.65 1.07 

Discharge planning means more paperwork 
9 

(3%) 

32 

(10.7%) 

69 

(23%) 

102 

(34%) 

88 

(29.3%) 
3.76 1.07 

Discharge planning is beneficial for the patients 
14 

(4.7%) 

36 

(12%) 

47 

(15.7%) 

109 

(36.3%) 

94 

(31.3%) 
3.77 1.15 

Discharge planning is difficult when patient recovery is not certain 
12 

(4%) 

30 

(10%) 

52 

(17.3%) 

120 

(40%) 

86 

(28.7%) 
3.79 1.08 

Discharge planning is not a priority 
17 

(5.7%) 

66 

(22%) 

45 

(15%) 

99 

(33%) 

73 

(24.3%) 
3.48 1.23 

Discharge planning should be the responsibility of the bedside nurse 
15 

(5%) 

41 

(13.7%) 

55 

(18.3%) 

104 

(34.7%) 

85 

(28.3%) 
3.67 1.16 

Patients are normally discharged before midday 
17 

(5.7%) 

31 

(10.3%) 

58 

(19.3%) 

111 

(37%) 

83 

(27.7%) 
3.70 1.14 

Patients are normally discharged to a ‘discharge lounge’ or something similar 
12 

(4%) 

50 

(16.7%) 

47 

(15.7%) 

113 

(37.7%) 

78 

(26%) 
3.65 1.15 

Patients are discharged any day of the week 
6 

(2%) 

29 

(9.7%) 

43 

(14.3%) 

122 

(40.7%) 

100 

(33.3%) 
3.93 1.02 

Mean 3.19 

Standard deviation 1.03 



31 

3.4 Who should co-ordinate discharge planning and the timing of discharge 

When reviewing the results presented in Table 3.4 below, we note that the overall mean 

score for who should coordinate discharge planning and the timing of discharge is M = 

3.71. This means that 74.2% are familiar with the coordination of discharge planning and 

the timing of discharge, It was noticed that 71% of the nurses who completed the 

questionnaire prepared for discharge planning when patients entered their care 

departments, and 70.6% of the nurses participating in the study supported discharge 

planning from the hospital. It was also noted in the results that discharge planning must 

be prepared when requested by the person responsible for the patient or the family. 73.3% 

agree or strongly agree that discharge planning should begin when requested by the 

physician; 74% of participating nurses agree or strongly agree that discharge planning 

should begin when requested by other health professionals; and 67.7% agree or agree that 

the patient is informed of the expected date of discharge. The highest mean score was for 

discharge planning, which should begin when requested by other health professionals, 

with M = 3.93 and SD = 1.04. When I looked at the average estimated discharge date for 

each patient, M = 3.78, SD = 1.07. 



32 

Table 3.4 

Who should co-ordinate discharge planning and the timing of discharge 

Question 
Strongly 

disagreed 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

Once the patient enters the unit, the discharge planning process begins 
17 

(5.7%) 

45 

(15%) 

25 

(8.3%) 

129 

(43%) 

84 

(28%) 
3.72 1.18 

Immediately before the patient leaves the unit, the discharge planning process begins 
14 

(4.7%) 

38 

(12.7%) 

49 

(16.3%) 

120 

(40%) 

79 

(26.3%) 
3.70 1.12 

Discharge planning begins when the family requests it 
16 

(5.3%) 

41 

(13.7%) 

31 

(10.3%) 

118 

(39.3%) 

94 

(31.3%) 
3.77 1.18 

When the doctor requests it, preparation of the discharge plan begins 
6 

(2%) 

37 

(12.3%) 

37 

(12.3%) 

130 

(43.3%) 

90 

(30%) 
3.87 1.04 

When the other health professionals requests it, preparation of the discharge plan begins 
10 

(3.3%) 

23 

(7.7%) 

45 

(15%) 

120 

(40%) 

102 

(34%) 
3.93 1.04 

An discharge estimated date is provided for each patient 
8 

(2.7%) 

40 

(13.3%) 

45 

(15%) 

122 

(40.7%) 

85 

(28.3%) 
3.78 1.07 

Always inform patients of the expected discharge date 
10 

(3.3%) 

38 

(12.7%) 

49 

(16.3%) 

113 

(37.7%) 

90 

(30%) 
3.78 1.10 

Mean 3.71 

Slandered deviation 1.07 



33 

3.5 Specific skills are needed by nurses to carry out discharge planning 

We note that the overall mean score for specific skills needed by nurses to carry out 

discharge planning is M = 3.92. This means that 78.4% of nurses believe that 

implementing hospital discharge planning requires specific skills, As specific skills are 

needed by nurses to carry out discharge planning according to management and personal 

skills, the results illustrate that 77.3% of participants agree or strongly agree that problem-

solving skills are needed to complete the discharge plan. In addition, 72.4% of 

respondents agreed or strongly agreed that good communication skills are significant 

skills needed for carrying out a discharge plan. The highest mean score was in problem-

solving skills, with M = 4.04 and SD = 0.94.  

Table 3.5 

Management and personal skills  

Question 
Strongly 

disagree 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

Ability to solve 

problems 

5 

(1.7%) 

17 

(5.7%) 

46 

(15.3%) 

124 

(41.3%) 

108 

(36%) 
4.04 0.94 

Good communication 

skills 

7 

(2.3%) 

22 

(7.3%) 

54 

(18%) 

127 

(42.4%) 

90 

(30%) 
3.90 0.98 

Time management 

skills 

10 

(3.3%) 

30 

(10%) 

44 

(14.7%) 

127 

(42.3%) 

89 

(29.7%) 
3.85 1.06 

Good organizational 

skills 

3 

(1%) 

28 

(9.3%) 

53 

(17.7%) 

123 

(41%) 

93 

(31%) 
3.91 0.972 

Mean 3.92 

Standard deviation 0.98 

 

3.6 Discharge planning management 

The results of Table 3.6 show that the overall mean score for discharge planning 

management is M = 3.92. This means that 78.4% of nurses agree that discharge planning 

needs management, and 77.7% of participants agreed and strongly agreed that the nurse's 

ability and awareness of understanding the clinical assessment process are essential for 

implementing the discharge plan. Moreover, the results exhibit that 42.3% of participants 

agree and 31.3% strongly agree that having effective documentation knowledge and skills 

is needed to complete the discharge plan. The highest mean score was "being able to 

understand the clinical assessment process," with M = 3.99 and SD = 0.99.



34 

Table 3.6 

Discharge planning management 

Question 
Strongly 

disagreed 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

Being able to understand the clinical assessment process 7 

(2.3%) 

24 

(8%) 

36 

(12%) 

129 

(43%) 

104 

(34.7%) 
3.99 0.99 

Having effective documentation knowledge and skills 
14 

(4.7%) 

27 

(9%) 

38 

(12.7%) 

127 

(42.3%) 

94 

(31.3%) 
3.86 1.09 

Being knowledgeable about services 
11 

(3.7%) 

24 

(8%) 

38 

(12.7%) 

133 

(44.3%) 

94 

(31.3%) 
3.91 1.04 

Available systems and resources 
10 

(3.3%) 

24 

(8%) 

63 

(21%) 

118 

(39.3%) 

85 

(28.3%) 
3.81 1.04 

The nurse's ability to plan a safe discharge 
6 

(2%) 

30 

(10%) 

49 

(16.3%) 

122 

(40.7%) 

93 

(31%) 
3.88 1.02 

Challenge unnecessary discharges 
9 

(3%) 

52 

(17.3%) 

49 

(16.3%) 

106 

(35.3%) 

84 

(28%) 
3.68 1.14 

Mean 3.92 

Standard deviation 0.98 

 

 



35 

3.7 Barriers to conducting effective discharge planning 

3.7.1 Internal discharge planning systems 

The results of the below table show that the overall mean score for Internal discharge 

planning systems is M = 3.82. This means that 76.4% of nurses said that there are internal 

discharge planning system obstacles that affect discharge planning. 70% of the 

participants agree and strongly agree that delayed medical review is considered one of 

the barriers to effective discharge planning. Also, the results show that only 68.7% of 

participants disagreed or strongly disagreed that poor admission assessment is considered 

a barrier to effective discharge planning. The highest mean score was delayed medical 

review, with M = 3.83 and SD = 0.99. 



36 

Table 3.7.1 

Internal discharge planning systems 

Question 
Strongly 

disagreed 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

No planning or Poor 
10 

(3.3%) 

35 

(11.7%) 

68 

(22.7%) 

109 

(36.3%) 

78 

(26%) 
3.70 1.08 

Difficulty in accessing diagnostic facilities 
11 

(3.7%) 

42 

(14%) 

54 

(18%) 

113 

(37.7%) 

80 

(26.6%) 
3.69 1.11 

Incomplete documentation 
10 

(3.3%) 

37 

(12.3%) 

59 

(19.7%) 

113 

(37.7%) 

81 

(27%) 
3.72 1.09 

Medical review is delayed 
5 

(1.7%) 

30 

(10%) 

55 

(18.3%) 

130 

(43.3%) 

80 

(26.7%) 
3.83 0.98 

Patients were not given an expected discharge date 
7 

(2.3%) 

36 

(12%) 

56 

(18.7%) 

117 

(39%) 

84 

(28%) 
3.78 1.05 

Admission assessment is poor 
11 

(3.7%) 

35 

(11.7%) 

48 

(16%) 

116 

(38.6%) 

90 

(30%) 
3.79 1.10 

Mean 3.82 

Standard deviation 1.02 

 



37 

3.7.2 External discharge planning systems 

The results of the below table show that the overall mean score for external discharge 

planning systems is M = 3.94. This means that 78.8% of nurses said that there are external 

discharge planning system obstacles that affect discharge planning. 70% of the 

respondents agree and strongly agree that bed blocking is an external barrier to an 

effective discharge plan. Also, the results illustrate that 79.6% agree and strongly agree 

that lack of input from external services such as social services and psychiatric services 

is considered a barrier to effective discharge planning when I look at the mean for lack of 

input from external services such as social services and psychiatric services. The highest 

mean score was "Inadequate external services such as psychiatric services or social 

services," with M = 3.98 and SD = 0.90. 

Table 3.7.2  

External discharge planning systems  

Question 
Strongly 

disagree 
Disagree Neutral Agree 

Strongly 

agree 
Mean 

Standard 

deviation 

Blocking from bed 
8 

(2.7%) 

21 
(7%) 

61 
(20.3%) 

108 
(36%) 

102 
(34%) 

3.91 1.02 

Inadequate external 

services such as 

psychiatric services or 

social services. 

7 
(2.3%) 

15 
(5%) 

39 

(13%) 

154 
(51.3%) 

85 
(28.3%) 

3.98 0.90 

Mean 3.94 

Standard deviation 0.96 

 

3.8 Management/personal skills 

The results of the table 3.8, see appendix H show that the overall mean score for 

management and personal skills is M = 3.92. This means that 78.4% of nurses said that 

there are management and personal skills obstacles that affect discharge planning. 78% 

of participants agree or strongly agree that time issues are important management skills, 

and 75.6% of participants agreed or strongly agreed that poor staffing levels are 

considered one of the personal skills that make barriers against effective discharge 

planning. The highest mean score was poor staffing levels, with M = 4.03 and SD = 0.93. 



38 

3.9 differences in perceptions related to the DP among the  nurses 

Because the data is not normally distributed,Mann-Whitney U and Kruskal-Wallis H tests 

were used to explore differences in perceptions around the discharge planning process in 

the respondents’ unit. (P value = 0.05 was considered a significant point), the results of 

the present study exhibited significant differences between gender groups (P value = 

0.024), with a more positive perception in the male group with a mean rank of 161.67. 

Also, the results illustrate significant differences in nursing perception regarding position 

(P value =0.001). A post hoc test was done and revealed significant differences between 

a registered nurse and an assistant nurse (P value = 0.001).  

3.10 differences in perceptions related to who should coordinate discharge planning 

and the timing of discharge 

The results illustrated a significant relationship between position and perceptions about 

who should coordinate discharge planning and the timing of discharge (P value = 0.001). 

A post hoc test was done and revealed a significant relationship between another and a 

practical nurse (P value =0.044), between another and an assistant nurse (P value = 0.001), 

and between a registered nurse and an assistant nurse (P value =0.026). Moreover, the 

study's results illustrate a significant relationship between years of experience and 

perceptions about who should coordinate discharge planning and discharge timing. (P 

value = 0.045), a post hoc test was done and revealed a significant relationship between 

6–11 years and 20 years or more (P value =0.041). See Table 3.10, Appendix H. 

3.11 differences in perceptions related to important management and personal skills 

The results of the illustration table exhibited no significant differences in participants’ 

perceptions of important management and personal skills. See Table 3.11, Appendix H. 

3.12 differences in  perceptions related to discharge planning management 

The results of the illustration table exhibited no significant differences in participants’ 

perceptions of important management and personal skills. See Table 3.12, Appendix H. 



39 

3.13 Differences in perceptions toward internal discharge planning systems that form 

barriers to conducting effective discharge planning 

As for the association between participants' characteristics and perceptions toward 

internal discharge planning systems that form barriers to conducting effective discharge 

planning, the results illustrate a significant relationship with the workplace (P value 

=0.023). Moreover, the results exhibit a significant relationship with position (P value = 

0.024). See Table 3.13, Appendix H. 

3.14 differences in perceptions toward external discharge planning systems that 

form barriers to conducting effective discharge planning and experience 

The results of the present study illustrate a significant relationship with experience year 

(P value =0.034), the post hoc test shows a significant relationship between 5 years or 

less and 20 years or more (P value = 0.021). See Table 3.14, Appendix H. 

3.15 differences in perceptions toward the role of management and personal skills 

The results of the present study illustrate a significant relationship between experience 

years and the role of management and personal skills in preventing effective discharge 

planning (P value = 0.279). See Table 3.15, appendix H. 

3.16 Differences between types of hospitals in terms of discharge planning overall 

mean score 

Mann-Whitney U test conducted to assess the difference between governmental and 

private hospitals in terms of discharge planning overall mean score. This means 

participants who work in governmental hospitals have the same score as participants who 

work in private hospitals in terms of discharge planning. See Table 3.16, Appendix H. 

3.17 Correlation between nursing perceptions around the DP process and other 

dependent variables 

The results of the study showed that there is a relationship between nursing perceptions 

about the discharge planning process and the discharge planning aspect of the concept of 

required interpersonal skills and coordination, as measured by a criterion called the 

Spearman rank correlation coefficient test, barriers to conducting effective discharge 

planning, and management and personal skills. The results of the study showed that there 



40 

is a clear relationship between nursing perception and other variables. See Table 3.17, 

Appendix H. 

3.18 The association between the perceptions of the discharge planning process for 

adult patients from  who coordinates , skills and the barriers to effective 

A simple linear regression was calculated to predict perceptions of discharge planning in 

acute departments, skills needed by the nurse to carry out patient discharge planning, and 

barriers. 

coordinate the patient's discharge planning, and the timing is a significant predictor to 

perceptions of discharge planning. Regarding discharge planning in acute departments, a 

significant relationship was found between discharge planning and perception (F = 

146.524, p =<0.001) with an R2 = 0.330. These mean participants' perceptions increased 

by 1.743 when the discharge planning increased by 1 unit; see Table 3.18, Appendix H.. 

skills needed by the nurse to carry out patient discharge planning is a significant predictor 

to perceptions of discharge planning. Regarding skills, a significant relationship was 

found between skills and perception (F = 36.515, p = 0.001) with an R2 = 0.109. These 

mean participants' perceptions increase by 0.289 when skills increase by 1 unit; See Table 

3.18. 

Barriers to effective discharge planning in acute departments are a significant predictor 

to perceptions of discharge planning. Regarding the barriers, a significant relationship 

was found between barrier and perception (F = 117.789, p =<0.001) with an R2 = 0.283. 

These mean participants’ perceptions increase by 0.513 when skills increase by 1 unit; 

See Table 3.18. 



41 

Chapter Four 

Discussions and Conclusions 

This chapter includes a discussion of the questions and hypotheses of the study. At the 

end of this section, limitations, conclusions, and recommendations were added. 

The purpose of the research is to find out the extent of knowledge of nurses in the 

departments that provide care in Ramallah hospitals, especially the acute ones, in the 

process of discharge planning for adult patients, to know the role of hospitals and 

management in discharge planning, what skills help the nurse plan discharge for patients 

effectively, and to identify the dilemmas that prevent discharge planning well. However, 

in order to get rid of the dilemmas and for In order for the effectiveness of exit to be 

strong, it is necessary to understand the field to which the policy applies, and it is 

necessary to understand the situations, observations, and perceptions of the participants  
,Patients require continuous health care, so all registered nurses must be able to participate 

in discharge planning. 

4.1 Participants’ Socio-demographic Characteristics 

In the current study, 400 questionnaires were distributed to the nurses working in 

Ramallah hospitals' acute medical care departments. 

Nurses who agreed to participate were 300, with a response rate of 75%; this was related