Previous studies report up to 1.5% of patients decide not to follow health professionals’ advice and instead discharge themselves from hospital. This is significant when almost 15 million patients were admitted in the UK between 2009 and 2010. The reasons given for self-discharge include long waiting time, poor bedside manner, and failure of communication amongst hospital staff. As a result, self-discharge has been framed in negative terms particularly as these patients have higher readmission and in-hospital mortality rates. Therefore, when people decide to self-discharge, it has implications for hospital staff and the turmoil they experience surrounding the extent of their legal, moral and professional duty of care towards the self-discharging patients. Furthermore, the next of kin of self-dischargers can feel torn between supporting their loved one, and yet powerless in the face of practitioners. These implications are most pertinent when considering patients at the extremes of the life course e.g. pregnant women and new mothers and their new-borns, and older people and their adult children.
This project is interdisciplinary in nature, drawing on social sciences and humanities literature. During this project you will:
- have the opportunity to design and conduct an applied piece of interdisciplinary research
- gain experience of the NHS research ethics committee approval process
- learn and apply qualitative data methodology, such as ethnography and/or semi-structured in-depth interviews, and data analysis techniques, such as thematic analysis
- gain experience of conducting empirical research, which entails recruiting practitioners, patients and their next of kin, on a range of hospital wards e.g. geriatric, acute, general medical
The overall aims of the project are to explore:
- How healthcare professionals understand their legal, moral and professional duty of care in the face of the self-discharging patient
- The relationships between the next of kin, practitioners and patients in the context of self-discharge
The project in context
The project builds on pilot work undertaken by Dr Laura Machin. See the following website for details: http://www.lancaster.ac.uk/shm/research/projects/amsd/
The project is linked with a large grant application to the National Institute for Health Research, with clinical and academic colleagues at York, Sheffield and Oxford to address self-discharge practices.
Impact from the project
Linked with the proposed NIHR project stated above, it is anticipated that findings from this PhD will inform hospital best practices surrounding self-discharge, and provide guidance to those contemplating self-discharge.
The project is ideal for a budding researcher, with a social science, humanities, or health background, who wishes to build a career in health research. You will want to conduct a piece of research that has real-world impact on NHS practices, an interest in qualitative research, and be willing to read literature from a range of disciplinary backgrounds.
The supervisory team
The team are experienced health researchers from a range of disciplinary backgrounds. They have experience of conducting empirical research in the NHS.
Informal enquires about the project should be made directly to Dr Laura Machin. Applications are made by completing an application for PhD Medicine October 2017 through our online application system. Closing date, midnight 3rd April 2017