Discharge planning as part of daily nursing practice.

Nurses deal with planning posthospitalization care within increasingly urgent focused environments and amid competing priorities. The purpose of this qualitative study was to examine nurses' discharge planning efforts as these occurred in practice. Eight nurses were observed and interviewed as they cared for selected patients. Major findings indicate that nurses' expectations of patients' progress guided their discharge assessments, teaching, and planning over time. Discharge teaching was a prominent part of daily practice that became more specific as hospital discharge neared. A gap between observed and documented discharge planning efforts existed, which poses significant challenges for nurses in many positions.