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Holmberg K, Bergkvist K, Wengström Y, Hagelin CL. Dismantle and rebuild: the importance of preparedness and self-efficacy before, during and after allogeneic haematopoietic cell transplantation. J Cancer Surviv 2024:10.1007/s11764-024-01622-2. [PMID: 38829473 DOI: 10.1007/s11764-024-01622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE The aim of this study was to explore patients' experiences of being prepared for allogenic haematopoietic cell transplantation and to explore their perceived self-efficacy and preparedness for self-care after allogenic haematopoietic cell transplantation. METHODS Nine participants, who recently underwent allo-HCT, were interviewed regarding their views on preparedness, self-efficacy and self-care. The interviews were analysed using inductive qualitative content analysis. RESULTS An overarching theme, Life is taken apart, then you have to know how to put the pieces together, and four sub-themes: Convert information into something understandable; Taking responsibility, maintaining and preparing for an uncertain time in life; Balancing vigilance with independence; and Reorientating in an altered body places new demands on self-care illustrate the dismantlement of life during treatment and how actions and approaches can build a new life. CONCLUSIONS Both participants and healthcare professionals prioritised preparing for allo-HCT in the period before admission. However, during admission, preparation decreased and the time was not used for preparatory learning. This meant that participants were well prepared for the acute phase but unprepared for life after completion of treatment. Among the participants, self-efficacy was good. They sought information about taking care of their health before and in the aftermath of allo-HCT. IMPLICATIONS FOR CANCER SURVIVORS This study provides insight into, and knowledge about, how patients prepare before, during and after treatment. This knowledge should primarily be directed towards healthcare professionals to be used for future patients who may need advice and support, as well as continued preparation for a life after transplantation.
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Affiliation(s)
- Katarina Holmberg
- Karolinska Institutet, Stockholm, Sweden.
- Sophiahemmet University, Stockholm, Sweden.
| | - Karin Bergkvist
- Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Yvonne Wengström
- Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Carina Lundh Hagelin
- Karolinska Institutet, Stockholm, Sweden
- Marie Cederschiöld University, Stockholm, Sweden
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Ganefianty A, Songwathana P, Damkliang J. Readiness for hospital discharge perceived by caregivers of patients with traumatic brain injury: A cross-sectional study. BELITUNG NURSING JOURNAL 2024; 10:209-214. [PMID: 38690311 PMCID: PMC11056832 DOI: 10.33546/bnj.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/08/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background There is a growing emphasis on evaluating discharge readiness, particularly for those involved in the care of patients in transition. Caregivers supporting individuals with traumatic brain injury are a specific focus due to the potential impact of adequate discharge preparation on patient recovery and post-discharge outcomes. Objective This research aimed to evaluate the preparedness of caregivers for the discharge of patients with moderate or severe traumatic brain injury from the hospital. Methods This cross-sectional study was carried out in a tertiary hospital in Indonesia from January to April 2023 using the Indonesian adaptation of the Preparedness for Caregiving Scale. The study comprised seventy-four caregivers of individuals with traumatic brain injury, chosen through a purposive sampling approach based on pre-established inclusion and exclusion criteria. Data collection involved a questionnaire covering caregiver information (gender, age, education level, income, and psychological status) and discharge readiness. Descriptive statistics and correlation analyses, employing Pearson and chi-square, were conducted. Results Most caregivers were female (83.8%), spouses of patients (50%), and had a moderate education level (52.7%). The average age of caregivers was 43.7 ± 8.7 years, with an average duration of patient care of 4.22 ± 1.2 days and a monthly income of 220 US dollars. The mean score for readiness for hospital discharge was low (10.08 ± 1.91), indicating that caregivers were not adequately prepared for discharge. Age and education were significant factors (p <0.05) related to hospital discharge readiness. Conclusion This study emphasizes the importance of assessing caregiver readiness for the discharge of patients with traumatic brain injury from the hospital. Findings indicate a concerning trend of inadequate preparedness among caregivers, with factors such as age and education level significantly influencing readiness. The predominance of female caregivers, often spouses of patients, indicates the need for tailored support strategies. Prioritizing caregiver preparation and support, especially by nurses, is crucial for optimizing patient recovery and post-discharge outcomes.
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Affiliation(s)
- Amelia Ganefianty
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
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Feldbusch H, Schmidt M, Steeb EM, Paschek N, Nemesch M, Sartory Y, Brenner R, Nöst S. Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review. Heliyon 2024; 10:e26554. [PMID: 38439820 PMCID: PMC10909674 DOI: 10.1016/j.heliyon.2024.e26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness. Objective To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients. Design and methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped. Results Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument. Conclusions The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.
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Affiliation(s)
- Hanna Feldbusch
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
- Robert Bosch Hospital, Stuttgart, Germany
| | - Marita Schmidt
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
| | | | | | | | | | | | - Stefan Nöst
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
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Pellet J, Weiss M, Zúñiga F, Mabire C. Improving patient activation with a tailored nursing discharge teaching intervention for multimorbid inpatients: A quasi-experimental study. PATIENT EDUCATION AND COUNSELING 2024; 118:108024. [PMID: 37862876 DOI: 10.1016/j.pec.2023.108024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Preliminary effectiveness test of a novel structured personalized discharge teaching intervention for multimorbid inpatients. METHODS Using a 2-group sequential pre/post-intervention design, the sample comprised 68 pre-intervention control group and 70 post- intervention group participants. The discharge teaching intervention by trained clinical nurses used structured tools to engage patients and individualize discharge teaching. Outcomes measures included Patient Activation Measure, Readiness for Hospital Discharge Scale, Discharge Care Experiences Survey, and readmission with 10 days post-discharge. RESULTS The intervention had a statistically significant positive effect on improving patient activation (M=4.8; p = 0.05) from admission to post-discharge. The participation subscale of the Discharge Care Experiences Survey was higher in the intervention (M=4.1, SD=0.7) than the control group (M=3.8, SD=0.7; t (127)= -2.79, p = .01, effect size= .34). There were no significant between-group differences in Readiness for Hospital Discharge Scale and readmission. CONCLUSIONS Our results suggest that a structured personalized discharge teaching intervention can improve patient activation and participation in discharge care. Further refinement of the intervention is needed to evaluate and improve specific components of the intervention. PRACTICE IMPLICATIONS Structured personalized discharge teaching should include patient engagement strategies in the teaching-learning process.
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Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Franziska Zúñiga
- Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Lei S, Sun J, Wang C, Zhang X, Han W, Wang X, Xie J. Nurse-to-patient ratios and readiness for hospital discharge: A moderated mediation model. Nurs Open 2024; 11:e2047. [PMID: 38268295 PMCID: PMC10697126 DOI: 10.1002/nop2.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore whether and to what extent, nurse-patient assessment differences mediate the association between nurse-to-patient ratios and readiness for hospital discharge, and examine whether nurse-patient characteristics moderate the indirect and/or direct effect of mediation model. DESIGN A cross-sectional study was carried out from March 2021 to December 2022. METHODS A total of 523 pairs of gastrointestinal cancer patients with PICC and their nurses were recruited. All the participants were invited to complete the general information questionnaire and the Readiness for Hospital Discharge Scale. Outcome measure was patient-reported readiness for hospital discharge. This study was reported according to the STROBE checklist. RESULTS The patients reported a low level of readiness for hospital discharge. Nurse-patient assessment differences were positively associated with nurse-to-patient ratios but negatively associated with readiness for hospital discharge. Furthermore, nurse-patient assessment differences fully mediated the effect of nurse-to-patient ratios on readiness for hospital discharge, and age and gender of patients only moderated the indirect path of mediation model.
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Affiliation(s)
- Shuang‐yan Lei
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Jia‐ru Sun
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Cai‐hua Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐fang Zhang
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Wen‐jin Han
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐qin Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Juan Xie
- Department of NursingShaanxi Provincial Cancer HospitalXi'anShaanxiChina
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Zhang R, Wang D, Zhu L, He Y, Cheng L, Ma J, Zhang T, Zhang J, Li L. Research trends in readiness for hospital discharge between 2002 and 2021: A bibliometric analysis. Nurs Open 2023; 10:7676-7693. [PMID: 37775985 PMCID: PMC10643845 DOI: 10.1002/nop2.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM This study aimed to undertake a bibliometric analysis to provide comprehensive information in demonstrating the current status and outline the overall trends in the area of readiness for hospital discharge (RHD). DESIGN A bibliometric and visual analysis of RHD literature was undertaken. METHODS Articles were retrieved from the Web of Science network from 2002 to 2021. VOSviewer was used to identify the co-authorship network of countries/institutions, co-authorship and co-citation analysis of authors, and co-citation analysis of references and citation analysis of documents. CiteSpace was used to identify the keyword co-occurrence network and perform cluster analysis, detecting the keywords with citation bursts and speculated frontiers in this research field. RESULTS A total of 512 articles were included in the final analysis. Key findings are: (1) There has been a continuous but somewhat fluctuating rise in the number of publications. (2) 56.05% of publications come from the USA with Marquette University making the highest contribution. (3) Most publications (17, 3.32%) in RHD research were from the Journal of Clinical Nursing, and Anaesthesia and Analgesia had the highest number of citations (584 citations). (4) Weiss ME (25, 4.88%) was the most productive author whose articles have been the most highly cited (646 citations). (5) Cited references from Weiss ME (2007) also made the largest contribution to co-citations, and the most cited reference was from Jack BW (2009) (1022 citations). (6) The 20 most frequent keywords and keywords with the strongest citation bursts were retrieved. There were seven research hotspots, and three emerging research frontiers were explored. CONCLUSIONS The bibliometric analysis of material published in the last 20 years indicates that there have been statistically significant gains in comprehensive information on RHD, including the knowledge mapping of the countries, institutions, authors, references and keywords. The hotspots and frontiers, which have been explored can give guidance to researchers as to new angles and directions to take. IMPLICATIONS FOR NURSING MANAGEMENT The effects of the implementation of ERAS on RHD-related risk for adverse post-discharge outcomes in surgical patients will be of increasing concern for healthcare professionals. It is important for patients and their relatives to be confident that on discharge they are sufficiently ready for hospital discharge to enable them to safely and smoothly make the transition to home. Improving the level of RHD in discharged patients can help nurse managers and researchers measure the effectiveness of discharge planning services.
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Affiliation(s)
- Rong Zhang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Dongmei Wang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Zhu
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Yongdong He
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Cheng
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jifen Ma
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ting Zhang
- Department of Thoracic, Cardiac, and Great Vascular Surgery, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jun Zhang
- School of NursingWuhan UniversityWuhanChina
| | - Longti Li
- Nursing Department, Taihe HospitalHubei University of MedicineShiyanChina
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Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, Bristol AA, Elmore CE. Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients. DISCOVER HEALTH SYSTEMS 2023; 2:45. [PMID: 38045443 PMCID: PMC10689550 DOI: 10.1007/s44250-023-00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Background COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients. Objective To understand the impact of pandemic-related system effects on patient-reported discharge preparation. Design This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021. Participants 616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences. Main measures Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing). Key results Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation. Conclusions While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00060-8.
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Affiliation(s)
- Andrea S. Wallace
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, USA
| | | | | | | | - Mackenzie Elliott
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Alycia A. Bristol
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Catherine E. Elmore
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
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Changjun C, Jingkun L, Yun Y, Yingguang W, Yanjun R, Debo Z, Kaining Z, Pengde K. Enhanced Recovery after Total Joint Arthroplasty (TJA): A Contemporary Systematic Review of Clinical Outcomes and Usage of Key Elements. Orthop Surg 2023; 15:1228-1240. [PMID: 36971112 PMCID: PMC10157715 DOI: 10.1111/os.13710] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a pathway designed to improve the care of surgical patients and achieve early recovery. The clinical outcomes and usage of key elements of ERAS pathways in total joint arthroplasty (TJA) need further reanalysis. This article aims to provide an overview of the latest clinical outcomes and current usage of key elements of ERAS pathways in TJA. METHODS We undertook a systematic review of the PubMed, OVID, and EMBASE databases in February 2022. Studies investigating the clinical outcomes and usage of key elements of ERAS in TJA were included. The components of successful ERAS programs and their usage were further determined and discussed. RESULTS Twenty-four studies involving 216,708 patients assessed ERAS pathways for TJA. A total of 95.8% (23/24) of studies reported a reduced length of stay (LOS), followed by reduce overall opioid consumption or pain (87.5% [7/8]), save costs (85.7% [6/7]), improvements in patient-reported outcomes or functional recovery (60% [6/10]), and reduced incidence of complications (50% [5/10]). In addition, preoperative patient education (79.2% [19/24]), anesthetic protocol (54.2% [13/24]), use of local anesthetics for infiltration analgesia or nerve blocks (79.2% [19/24]), perioperative oral analgesia (66.7% [16/24]), perioperative surgical factors including reduced use of tourniquets and drains (41.7% [10/24]), use of tranexamic acid (41.7% [10/24]) and early mobilization (100% [24/24]) were contemporary comparatively "active" components of ERAS. CONCLUSIONS ERAS for TJA has favorable clinical outcomes in terms of reducing LOS and overall pain, saving costs, accelerating functional recovery, and reducing complications, although the evidence is still low in quality. In the current clinical scenario, only some "active" components of the ERAS program are widely used.
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Affiliation(s)
- Chen Changjun
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Li Jingkun
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Yang Yun
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Wu Yingguang
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Ren Yanjun
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Zou Debo
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Zhang Kaining
- Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Kang Pengde
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Guan M, Feng X. Correlation between quality of discharge teaching, readiness for hospital discharge and health outcomes of hysterectomy patients: A structural equation model analysis. Nurs Open 2023; 10:3817-3827. [PMID: 36802197 PMCID: PMC10170923 DOI: 10.1002/nop2.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 02/04/2023] [Indexed: 02/20/2023] Open
Abstract
AIM To explore the relationship between the quality of discharge teaching, readiness for hospital discharge and postdischarge health outcomes in hysterectomy patients. DESIGN Cross-sectional online survey. METHODS A cross-sectional survey design was used to investigate 331 hysterectomy patients in a hospital in Chengdu. The results were analysed using Spearman's correlation and structural equation model. RESULTS Spearman's correlation analysis revealed moderate-to-strong correlations among the quality of discharge teaching, readiness for hospital discharge and postdischarge health outcomes. The total and direct effects of the quality of discharge teaching on patients' readiness for hospital discharge were both 0.70 and readiness for hospital discharge on patients' postdischarge health outcomes were both 0.49. The total, direct and indirect effects of the quality of discharge teaching on patients' postdischarge health outcomes were 0.58, 0.24 and 0.34, respectively. Readiness for hospital discharge mediated the interaction mechanism.
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Affiliation(s)
- Meijun Guan
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China.,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianqiong Feng
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
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Qiu C, Feng X, Zeng J, Jiang Y. Relationships between Cataract Surgery Patient-Perceived Discharge Teaching Quality, Discharge Readiness, and Post-Discharge Outcomes: A Cross-Sectional Study Based on Regression Modeling Analysis. Ophthalmic Res 2022; 66:328-338. [PMID: 36353771 DOI: 10.1159/000527958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2023]
Abstract
INTRODUCTION A short hospital stay makes discharge planning services especially critical for patients undergoing cataract surgery. Studies on discharge teaching quality, discharge readiness, and post-discharge outcomes for patients with cataracts are lacking. Our study aimed to explore the relationships between the perceived discharge teaching quality, discharge readiness, and post-discharge outcomes of cataract surgery patients and to conduct a differential analysis between inpatient and day ward patients. METHODS We recruited 387 patients from the ophthalmology ward of a top-tier hospital in western China through convenience sampling. Data were collected on the day of discharge and at 2 weeks post-discharge. Statistical methods included multiple linear regression analysis, χ2 test, and the Mann-Whitney U test. RESULTS Regression models indicated that discharge teaching quality was the key factor of discharge readiness, while post-discharge outcomes were influenced by discharge readiness and discharge teaching quality. Further, inpatients' discharge teaching quality, discharge readiness, and post-discharge subjective feelings were better than those of day ward patients. CONCLUSIONS The effect of discharge planning services on patients undergoing cataract surgery was generally satisfactory. High-quality discharge teaching can enhance patients' discharge readiness, further improving their post-discharge outcomes. When conducting discharge teaching, day ward medical staff should pay more attention to patients' demands and explore a more effective teaching delivery method.
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Affiliation(s)
- Chujin Qiu
- West China School of Nursing, Sichuan University, Chengdu, China,
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Xianqiong Feng
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jihong Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Perera T, Grewal E, Ghali WA, Tang KL. Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study. BMJ Open Qual 2022; 11:bmjoq-2022-001875. [PMID: 36375857 PMCID: PMC9664267 DOI: 10.1136/bmjoq-2022-001875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background At hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes. Methods We conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome—90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome. Results A total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6–100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item—not understanding warning signs and symptoms—was (adjusted OR 3.46 (95% CI 1.02 to 11.73)). Conclusion Perceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.
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Affiliation(s)
- Tefani Perera
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eshleen Grewal
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada.,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada .,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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12
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Cook JLE, Fioratou E, Davey P, Urquhart L. Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach. BMJ Open Qual 2022; 11:bmjoq-2021-001810. [PMID: 35998981 PMCID: PMC9403153 DOI: 10.1136/bmjoq-2021-001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains by the end of April 2021. Pre-intervention most patients received verbal instructions and only a minority received written information. Through staff interviews, we identified the electronic discharge document (EDD) as a practical source of written information. However, testing with patients showed that the format required substantial redesign to be written in patient-friendly language, using signposting, spacing information out and avoiding jargon. The effect of this intervention was assessed with a structured telephone questionnaire, which included both a patient self-rated score and a comparative understanding score to assess true patient understanding of the revised EDD. Pre-intervention 29 discharged patients were interviewed across 10 days and post-intervention 10 patients were interviewed in 7 days. Patients consistently over-rated their understanding of discharge information. Only one patient achieved the aim of comparative understanding >4 across all domains post-intervention. Understanding improved across all but one of the domains, the exception being medication changes. An important unanticipated consequence was that interviews identified inconsistencies in EDD information and gaps in patient understanding, which required escalation to the SSU team. In summary, this intervention improved patient understanding across four of the five domains. However, further work is required on process reliability for the redesigned EDD and on improving understanding of medication changes. Furthermore, the interviews revealed clinically important inconsistencies in EDD information and gaps in patient understanding.
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Affiliation(s)
| | | | - Peter Davey
- University of Dundee School of Medicine, Dundee, UK
| | - Lynn Urquhart
- Infectious Diseases and Acute Medicine, NHS Tayside, Dundee, UK
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13
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Meng L, Lingling Z, Haihong Z, Xiaobai Z, Dandan H, Shaoyan W. Readiness for Hospital Discharge and Its Correlation with the Quality of Discharge Teaching among the Parents of Premature Infants in NICU. Appl Bionics Biomech 2022; 2022:4924021. [PMID: 35874642 PMCID: PMC9300354 DOI: 10.1155/2022/4924021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the extent of the readiness for hospital discharge and the correlation with discharge teaching quality among parents of premature infants' in the NICU. Background Low readiness for discharge from the hospital can lead to negative outcomes in healthcare for infants born prematurely and their parents. Discharge guidelines are a basic approach to ensure the readiness of the parents for discharge from the hospital. No investigation has ever been conducted into the sufficiency of hospital discharge guidelines for premature infants and their impact on parental readiness for hospital discharge. Design Data was collected from four hospitals in China using a correlational descriptive study. Methods Two hundred and eight parents of premature NICU-hospitalized infants of four tertiary hospitals in Henan Province from May to October 2020 were enrolled. The general information questionnaire, the readiness for hospital discharge scale- (RHDS-) parent form, and the quality of discharge teaching scale- (QDTS-) parent form were used for data collection. Spearman correlation analysis and descriptive statistics were used to analyze the data. Results The total score for hospital discharge readiness was high (8.05 ± 1.11). The total score of the quality of discharge guidelines was moderate (7.44 ± 1.44). Moreover, the discharge teaching quality was positively correlated with the parents' readiness. Positive correlations were found between PRHDS and QDTS subscales, including content received and delivery, physical-emotional status, knowledge, and expected support. Conclusion The quality of the discharge guidelines perceived by parents of premature infants was moderate, which may have reduced their readiness for hospital discharge. Relevance to Clinical Practice. This study furnishes basic information on the importance of readiness of discharge for the parents of premature infants. The teaching guides nurses to enhance the quality of discharge teaching and the readiness of parents for discharge from the hospital.
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Affiliation(s)
- Li Meng
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhang Lingling
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhang Haihong
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhang Xiaobai
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Huang Dandan
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Wu Shaoyan
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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14
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Lu F, Zhang G, Zhao X, Luo B. Readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia. J Clin Nurs 2021; 31:3213-3221. [PMID: 34877719 DOI: 10.1111/jocn.16159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/11/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate existing status and factors affecting the readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia in China. BACKGROUND Acute lymphoblastic leukaemia is the most common childhood cancer, but there is not enough research on the readiness for hospital discharge. DESIGN A cross-sectional study was performed by convenience sampling and questionnaire survey. METHODS A self-developed questionnaire of general and clinical characteristics of patients, self-developed questionnaire of general status of family and primary caregivers, questionnaire of readiness of hospital discharge scale and social support rating scale for primary caregivers were delivered to 264 primary caregivers of childhood acute lymphoblastic leukaemia patients. Data collection was carried out 24 h before discharge at bedside. In this study, the STROBE checklist was followed. RESULTS In total, 253 patients aged 0-16 years, including their primary caregivers in the hospital, were included from November 2016 to August 2017. Based on the readiness scale, the total mean score of readiness was 157.36. Based on the social support scale, the total mean score was 42.17. According to multivariate analysis, periods of chemotherapy (p < .001), complications (p = .019), family economic situation (p = .023), understanding of leukaemia (p < .001), objective support (p = .004), subjective support (p < .001) and availability of support (p = .045) were the main influencers of readiness. CONCLUSIONS The readiness for hospital discharge in primary caregivers for childhood lymphoblastic leukaemia patients is not satisfactory in China. RELEVANCE TO CLINICAL PRACTICE This study has implications for public health administration, asking for better community services and disease education. In addition, more effort should be made to provide high-quality family and primary caregiver assessments and discharge education by nurses.
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Affiliation(s)
- Feng Lu
- West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education, Chengdu, China
| | - Ge Zhang
- West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education, Chengdu, China
| | - Xiufang Zhao
- West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education, Chengdu, China
| | - Biru Luo
- West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education, Chengdu, China
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15
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Xiong L, Liu Y, Chen Q, Tian Y, Yang M. Readiness for Hospital Discharge of Adult Patients with Major Depressive Disorder in China: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1681-1692. [PMID: 34354344 PMCID: PMC8331081 DOI: 10.2147/ppa.s319447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Being ready for discharge is vital to successful hospital-to-home transitions. However, despite a wealth of evidence on its effectiveness, little is known about readiness for hospital discharge (RHD) in adult patients with major depressive disorder (MDD) and its influencing factors. In this study, we investigated the patient-reported RHD and its influencing factors among Chinese adult patients with MDD. PATIENTS AND METHODS In this cross-sectional design study, 230 adult patients with MDD were recruited according to the inclusion and exclusion criteria, 6 were excluded due to incomplete questionnaires, finally 224 patients were included in our study. Data were collected from March to September 2019 in a tertiary general hospital in Hunan Province (China). The general information, RHD, quality of discharge teaching and level of depression were assessed by using questionnaires. Univariate analysis and ordinal logistic regression analysis were performed to explore the influencing factors of RHD. RESULTS The RHD score was 7.37 ± 1.40, and 36.2% of participants were not ready for discharge. The score of quality of discharge teaching scale (QDTS) was 6.36 ± 1.89, the dimension of delivery scored highest, followed by content-needed and content-received. The proportions of patients with no, mild, moderate, moderately severe and severe depression were 12.5%, 27.7%, 25.0%, 25.4% and 9.4%, respectively. The following factors were associated with RHD: the level of depression (OR=0.66), the content-received dimension of QDTS (OR=1.16), education level (OR=1.24), work status (OR=1.76) and length of hospitalization (OR=0.53). CONCLUSION The RHD among participants was at a moderate level. It is strongly suggested to take the assessment of RHD as a routine process. High education level, employment and the content-received dimension of QDTS were protective factors of participants' RHD, and long-term hospitalization, the high level of depression were its risk factors.
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Affiliation(s)
- Lile Xiong
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Yingying Liu
- West China Hospital Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Qiongni Chen
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Yusheng Tian
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Min Yang
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, People’s Republic of China
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16
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Exploring the Role of Social Support between Discharge Teaching and Readiness for Discharge in Ocular Fundus Disease Patients: A Cross-Sectional Study. J Ophthalmol 2021; 2021:5547351. [PMID: 34239719 PMCID: PMC8233073 DOI: 10.1155/2021/5547351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to evaluate the quality of discharge teaching and readiness for discharge of fundus disease patients treated with day surgery and understand the role of social support between them. Methods This was a cross-sectional descriptive correlational survey. Through convenient sampling, fundus disease patients treated with day surgery from Zhongshan Ophthalmic Center, China, were recruited. Data were collected using demographic and disease-related information, quality of discharge teaching scale, readiness for hospital discharge scale, and social support scale. Results 255 fundus disease patients treated with day surgery were recruited at last. The mean total score of readiness for discharge, quality of discharge teaching, and social support in patients with fundus disease were 157.91 (SD = 26.68), 122.97 (SD = 21.55), and 36.32 (SD = 7.60), respectively. Participants with stronger social support had better discharge teaching and then had higher readiness for discharge. Social support played a partial mediator role in the relationship between discharge teaching and readiness for discharge. The mediation effect ratio was 5.5%. Conclusions The quality of discharge teaching and social support among fundus disease patients who underwent day surgery was relatively high, and readiness for discharge was good. Social support is essential for the quality of discharge teaching and the improvement of discharge readiness. Clinical nurses need to provide appropriate guidelines to help patients seek effective support and improve quality of discharge teaching to enhance the readiness for discharge of fundus disease patients treated with day surgery.
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17
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Postcraniotomy Patients' Readiness for Discharge and Predictors of Their Readiness for Discharge. J Neurosci Nurs 2021; 52:295-299. [PMID: 32956132 DOI: 10.1097/jnn.0000000000000554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship between demographic and clinical characteristics of postcraniotomy individuals and their readiness for discharge was examined. METHODS A descriptive correlational study included 150 individuals. The Readiness for Hospital Discharge Scale and demographic variables were examined using descriptive statistics, correlation, and stepwise multiple linear regression. RESULTS The mean postcraniotomy score for the subdimension of knowledge related to readiness for discharge was 5.13 ± 3.04, and mean score for the whole scale was 7.76 ± 1.48. The individuals' age, employment status, presence of a person to provide care at home, poor financial status, and first hospitalization during the lifetime of the patient were statistically significant predictors of their readiness for discharge. This model was statistically significant (F = 25.572, P < .001) and accounted for 57% of the variance in discharge readiness. CONCLUSION Patients had moderate levels of readiness for discharge and low levels of discharge-related knowledge. The findings point to the importance of individual approach to the discharge planning.
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18
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Wang M, Wang Y, Meng N, Li X. The factors of patient-reported readiness for hospital discharge in patients with depression: A cross-sectional study. J Psychiatr Ment Health Nurs 2021; 28:409-421. [PMID: 32981173 DOI: 10.1111/jpm.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/25/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The attributes of readiness for hospital discharge (RHD) have been identified to be physical stability, adequate support, psychological ability, and adequate information and knowledge. Patient-reported RHD has been regarded as an outcome indicator, and poor RHD leads to unplanned readmission, emergency department visits and even death. Knowledge regarding patient-reported RHD and its factors among patients with depression is limited. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: RHD among patients with depression is at a moderate level. More than a quarter of people with depression had low RHD. The knowledge dimension of the RHDS among patients with depression should be further strengthened. The length of stay, content received and delivery dimensions of the QDTS were significantly associated with RHD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study encourages nurses to assess patient-reported RHD at discharge in mental health settings. Nurses should pay more attention to patients with hospital stays longer than 20 days. Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content. Nurses' managers could develop programmes to improve teaching skills via Internet technology, such as simulated patients and online interprofessional discharge planning. ABSTRACT: Introduction Low readiness for hospital discharge (RHD) can be followed by negative healthcare outcomes. However, no studies have investigated RHD among patients with depression. Aim This study aimed to examine patient-reported RHD and its factors among patients with depression. Method In total, 367 inpatients with depression were recruited and completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). A binary logistic regression analysis was performed to explore the factors of RHD among patients with depression. Results The total RHDS score was 7.70 ± 1.52. Approximately 28.9% of the participants had low RHD (RHDS score < 7). The results revealed that RHD was significantly associated with the length of stay, content received and delivery. Discussion RHD among patients with depression is at a moderate level. More than a quarter of people with depression had low RHD. To improve RHD, enhancing the quality of discharge teaching is imperative for patients with depression. Implications for Practice Nurses should pay more attention to patients with a hospital stay longer than 20 days. Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content.
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Affiliation(s)
- Mengmeng Wang
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China
| | - Ya Wang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Na Meng
- Mental Health Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaolin Li
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China
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19
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Pellet J, Weiss M, Zúñiga F, Mabire C. Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol. Pilot Feasibility Stud 2021; 7:71. [PMID: 33731212 PMCID: PMC7968193 DOI: 10.1186/s40814-021-00812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions. METHODS This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses' teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients' activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission. DISCUSSION The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (ID: NCT04253665 ) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).
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Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Marianne Weiss
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Franziska Zúñiga
- Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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20
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Rotvig C, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Juel K, Thorup CB, Mols RE, Berg SK. Unreadiness for hospital discharge predicts readmission among cardiac patients: results from the national DenHeart survey. Eur J Cardiovasc Nurs 2021; 20:667-675. [PMID: 33713110 DOI: 10.1093/eurjcn/zvab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/18/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
AIMS Readiness for hospital discharge describes a patient's perception of feeling prepared to leave the hospital. In mixed patient populations, readiness for hospital discharge has shown to predict readmission and mortality in the short term. The objectives of a population of men and women with cardiac diseases, were to investigate: (i) whether readiness for hospital discharge predicts readmission and mortality within 1-year post-discharge, as well as (ii) the association between 'physical stability', 'adequate support', 'psychological ability', and 'adequate information and knowledge' and readiness for hospital discharge. METHODS AND RESULTS Data from the national cross-sectional survey DenHeart were used and included patients with cardiac diseases at hospital discharge. Readiness for hospital discharge was evaluated by one self-reported question, and attributes were illuminated by Short-Form-12, the Edmonton Symptom Assessment Scale and ancillary questions. Data were combined with national registries at baseline and at 1-year follow-up. Cox proportional-hazards model were used to regress readmission and mortality. The analysis included 13 114 patients (response rate: 52%). The majority responded that they felt ready for hospital discharge (95%). Feeling unready (n = 618) was a predictor of 1 year, all-cause readmission among women and men [hazard ratio (HR) = 1.43, 95% confidence interval (CI) 1.18-1.74; HR = 1.59, 95% CI 1.34-1.90]. No significant results were found on all-cause mortality. The four attributes were associated with unreadiness at hospital discharge. CONCLUSION Not feeling ready for hospital discharge was a predictor of increased readmission risk in women and men with cardiac disease during 1 year after hospital discharge. Four attributes were significantly impaired in patients feeling unready for hospital discharge.
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Affiliation(s)
- Camilla Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Vinggaard Christensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte hospitalsvej 1, 2900 Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Reberbansgade 9000 Aalborg, Denmark.,Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Reberbansgade 9000 Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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21
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O'Connor M, Moriarty H, Schneider A, Dowdell EB, Bowles KH. Patients' and caregivers' perspectives in determining discharge readiness from home health. Geriatr Nurs 2021; 42:151-158. [PMID: 33444923 DOI: 10.1016/j.gerinurse.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/24/2022]
Abstract
There are no national, empirically derived clinical decision support tools to assist the interprofessional home health team in determining readiness for discharge from skilled home health. Eliciting patient and family caregiver perspectives around readiness for home health discharge is integral to developing tools that address their needs in this decision-making process. The purpose of this study was to describe the factors home health patients and their family caregivers perceive as critical when determining readiness for discharge from services. A qualitative descriptive study was conducted among skilled home health recipients and their family caregivers who were either recently discharged or recertified for additional care from two different Medicare-certified skilled home health agencies. Nine themes emerged: self-care ability, functional status, status of condition(s) and symptoms, presence of a caregiver, support for the caregiver, connection to community resources/support, safety needs of the home environment addressed, adherence to the prescribed regimen, and care coordination.
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Affiliation(s)
- Melissa O'Connor
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States; Gerontology Interest Group, Villanova University, M. Louise Fitzpatrick College of Nursing, United States; NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States; Fellow, Betty Irene Moore Fellowships for Nurse Leaders and Innovators, United States.
| | - Helene Moriarty
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, United States; NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States
| | - Anne Schneider
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States
| | - Elizabeth B Dowdell
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States; Center for Home Care Policy & Research, Visiting Nurse Service of New York, United States
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22
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'There was no preamble': Comparing the Transition from Hospital to Home in Different Care Settings. Can J Aging 2020; 40:282-292. [PMID: 33190652 DOI: 10.1017/s0714980820000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers' optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients' previous experiences, needs, and care expectations.
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23
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Rio L, Tenthorey C, Ramelet AS. Unplanned postdischarge healthcare utilisation, discharge readiness, and perceived quality of teaching in mothers of neonates hospitalized in a neonatal intensive care unit: A descriptive and correlational study. Aust Crit Care 2020; 34:9-14. [PMID: 32800408 DOI: 10.1016/j.aucc.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/30/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Discharge teaching has been positively associated with discharge readiness in various care settings and patient types. Association of discharge readiness with unplanned use of health services has not received as much attention in the neonatal intensive care unit (NICU) population, but has been negatively associated in parents of older children. OBJECTIVES The objective of the study was to describe and assess relationships between maternal readiness for neonates' discharge, discharge teaching, and unplanned use of health services after discharge from an NICU. METHODS Mothers from an NICU of a tertiary referral hospital in Switzerland completed the "Readiness for Hospital Discharge Scale" and the "Quality of Discharge Teaching Scale parental forms" in the 24 h preceding discharge. Telephone interviews evaluating the unplanned use of health services were conducted 28 days after discharge. Simple linear regressions and multiple regressions were used to explore the links between the readiness, perceived quality of discharge, and unplanned use of health services. RESULTS Of the 71 participants, 75% (n = 53%) felt ready for discharge when asked directly, and for 60% (n = 42) of them, the amount of discharge teaching received was equal to or higher than that needed, but with high heterogeneity in scores. For 38% of mothers (n = 27), the expected support from the medical care of their child after discharge was deemed insufficient. In the month after discharge, unplanned use of health services occurred in 46% of the participants (n = 32). Perceived quality of teaching positively predicted readiness for discharge (R2 = 0.24, p = 0.0004). Unplanned use of health services correlated neither with readiness nor with perceived teaching quality. CONCLUSIONS At discharge, mothers felt mostly ready and well prepared to go home. In the month after discharge, almost half used health services in an unplanned manner. Further exploration of reasons leading to this high rate of postdischarge healthcare utilisation is warranted.
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Affiliation(s)
- Laura Rio
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Chloé Tenthorey
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Meng N, Liu R, Wong M, Liao J, Feng C, Li X. The association between patient-reported readiness for hospital discharge and outcomes in patients diagnosed with anxiety disorders: A prospective and observational study. J Psychiatr Ment Health Nurs 2020; 27:380-392. [PMID: 31943521 DOI: 10.1111/jpm.12592] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Readiness for hospital discharge (RHD) has been an important topic for nurses. RHD can be measured by the Readiness for Hospital Discharge Scale (RHDS), including 4 subscales: personal status, knowledge, coping ability and expected support. There are few studies that focus on RHD in patients diagnosed with mental disorders. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Improving patient-reported RHD can decrease the risks of unscheduled post-discharge clinic visits, readmission and poor quality of life (QOL) in patients diagnosed with anxiety disorders. Improving patient-reported personal status can decrease the risk of poor QOL in patients diagnosed with anxiety disorders. Improving patient-reported knowledge can decrease the risks of unscheduled post-discharge clinic visits and readmission in patients diagnosed with anxiety disorders. Improving patient-reported expected support can decrease the risk of unscheduled post-discharge clinic visits in patients diagnosed with anxiety disorders. Improving the methods of discharge teaching and anxiety severity can enhance RHD in patients diagnosed with anxiety disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses could enhance patient-reported RHD to reduce unscheduled post-discharge medical resource utilization or improve QOL by facilitating knowledge acquisition and skill development and improving social support systems. Nurse managers could add RHD assessment to patients' discharge process and train nurses in the methods of discharge education. Nurses could advance their methods of discharge education, such as listening to and answering patients' questions, choosing a convenient time and engaging in online education. ABSTRACT: Introduction The association between readiness for hospital discharge (RHD) and post-discharge outcomes remains unclear in individuals with anxiety disorders. Aim To explore the factors of RHD and the effect of patient-reported RHD on post-discharge outcomes. Method In the observational study, 373 patients diagnosed with anxiety disorders completed the self-administered Readiness for Hospital Discharge Scale (RHDS) on discharge. After 30 days, phone interviews were conducted to collect data on post-discharge outcomes, including self-reported unscheduled medical service utilization, symptom severity and quality of life (QOL). Multiple logistic regression models were built to explore the relationships among sociodemographic characteristics, the RHDS and its subscales, and post-discharge outcomes. Results The unscheduled clinic visits were significantly associated with low RHD, knowledge and expected support. Readmission was significantly associated with low RHD and knowledge. Poor QOL was significantly associated with low RHD and personal status. Delivery, received content and anxiety severity were the predictors of RHD. Discussion Improved RHD is associated with fewer unscheduled clinic visits and readmissions and better QOL. Enhancing discharge education can improve RHD. Implications for practice Nurses should enhance patient-reported RHD to improve post-discharge outcomes by advancing the quality of discharge education in patients diagnosed with anxiety disorders.
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Affiliation(s)
- Na Meng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Ruian Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Mengmeng Wong
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jingping Liao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Chi Feng
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaolin Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
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Zhao H, Feng X, Yu R, Gu D, Zhang X. Factors influencing readiness for hospital discharge among patients undergoing laryngectomy. Int J Nurs Pract 2020; 26:e12875. [PMID: 32671969 DOI: 10.1111/ijn.12875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 05/17/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023]
Abstract
AIM To identify factors influencing readiness for hospital discharge among Chinese patients having undergone a laryngectomy and to provide evidence for developing future processes. BACKGROUND Laryngectomy changes the functional and psychological state of laryngeal cancer patients considerably. However, influencing factors for discharge readiness among laryngectomy patients have hardly been investigated. METHODS A descriptive, cross-sectional design was used with Meleis' transitions theory as a guiding framework. This survey-based study was performed with 212 laryngeal cancer patients undergoing laryngectomy at a regional tertiary medical centre between August 2012 and September 2013. RESULTS Quality of discharge teaching and having a designated caregiver after discharge were found to influence patients' readiness for discharge. CONCLUSION Clinical interventions such as nursing assessment on discharge readiness, assistance to coordinate postdischarge support and individualized follow-up planning should be integrated into future clinical processes in China. However, further investigations are needed to systematically align relevant results before clinical practices in Chinese settings are eventually changed.
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Affiliation(s)
- Huiling Zhao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xianqiong Feng
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deying Gu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyan Zhang
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Considine J, Berry D, Sprogis SK, Newnham E, Fox K, Darzins P, Rawson H, Street M. Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study. BMJ Open 2020; 10:e034728. [PMID: 32439693 PMCID: PMC7247374 DOI: 10.1136/bmjopen-2019-034728] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience. DESIGN A qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics. SETTING Three acute care hospitals from one health service in Australia. PARTICIPANTS Patients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission. FINDINGS Thirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: 'experiences of care', 'hearing and being heard', 'what's wrong with me', 'not just about me' and 'all about going home'. There was considerable variability in patients' and carers' experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital. CONCLUSIONS The study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Debra Berry
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Stephanie K Sprogis
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Evan Newnham
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Karen Fox
- Eastern Health, Box Hill, Victoria, Australia
| | - Peteris Darzins
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Helen Rawson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Monash Health Partnership, Clayton, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
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Chen C, Zhang X, Tang C, Xiao X, Tao Z, Wang H. Psychometric properties of the Chinese Version of the Readiness for Hospital Discharge Scale for people living with HIV. Int J Nurs Sci 2020; 7:220-227. [PMID: 32685620 PMCID: PMC7355158 DOI: 10.1016/j.ijnss.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/04/2019] [Accepted: 12/25/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The study was conducted to validate the reliability and factor structure of the Chinese version of the Readiness for Hospital Discharge Scale (RHDS-CH) for people living with HIV (PLWH). Methods From May 2017 to November 2017, a cross-sectional survey was performed in two AIDS inpatient departments located in two cities in Hunan, China. Reliability was evaluated by examining the internal consistency and split-half reliability of the items. A confirmatory factor analysis was performed to assess the factor structure of the RHDS-CH, and the model was revised according to the modification index. Results Cronbach’s α for the RHDS-CH was 0.912, and the split-half reliability of the total scale was 0.831. Initially, the results of the confirmatory factor analysis indicated that the sample did not fit this four-factor model and its 23 items well (χ2/df = 3, GFI =0.772, TLI = 0.823, CFI = 0.844, RMSEA = 0.100). To improve the model fit indices, we performed model modification with the guidance of modification indices. Finally, the model fit indices showed an acceptable fit to the data (χ2/df = 2.141, GFI = 0.844, TLI = 0.899, CFI = 0.915, RMSEA = 0.075). Coefficients of corrected item-total correlation of the RHDS-CH ranged from 0.435 to 0.726. Conclusion This study is the first to examine the psychometric properties of the RHDS-CH for PLWH. Our findings showed good reliability and confirmed the four-factor structure model for PLWH.
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Affiliation(s)
- Chen Chen
- School of Nursing, Central South University, Hunan, China
| | - Xiaoxia Zhang
- Nursing Faculty, Henan Medical College, Henan, China
| | - Chulei Tang
- School of Nursing, Central South University, Hunan, China
| | - Xueling Xiao
- School of Nursing, Central South University, Hunan, China
| | - Zirong Tao
- Nursing Department, Xiangya Hospital, Central South University, Hunan, China
| | - Honghong Wang
- School of Nursing, Central South University, Hunan, China
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Shih TY, Lin LC, Wu SC, Yang MH. The effect of caregiver's and nurse's perception of a patient's discharge readiness on postdischarge medical resource consumption. J Adv Nurs 2020; 76:1355-1363. [PMID: 32056269 DOI: 10.1111/jan.14329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 11/27/2022]
Abstract
AIMS The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. DESIGN The study employed a descriptive research, prospective longitudinal study design. METHOD The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. RESULTS/FINDINGS The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. CONCLUSION Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. IMPACT Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.
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Affiliation(s)
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Man-Hua Yang
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Yang J, He Y, Jiang L, Li K. Colorectal patients' readiness for hospital discharge following management of enhanced recovery after surgery pathway: A cross-sectional study from China. Medicine (Baltimore) 2020; 99:e19219. [PMID: 32080116 PMCID: PMC7034666 DOI: 10.1097/md.0000000000019219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to ascertain the status quo of perceived readiness for hospital discharge in colorectal cancer patients who underwent enhanced recovery pathway and identify the variables that affect patients' perceptions about their readiness for discharge.A cross-sectional survey was conducted in West China Hospital, Sichuan University. The Readiness for Hospital Discharge Scale and the Quality of Discharge Teaching Scale were delivered to 130 colorectal cancer (CRC) patients who underwent enhanced recovery pathway. Data collection was carried out 4 hours before discharge.The total score of readiness for hospital discharge was 149.86 ± 33.65. The multiple linear regression analysis revealed that the quality of discharge teaching, discharge to a rehabilitative institution were associated with the readiness for hospital discharge.The level of CRC patients' readiness for hospital discharge needs to be improved. Medical staff should improve the quality of discharge guidance and pay more attention to patients transferred to rehabilitation institutions when they leave hospital.
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Affiliation(s)
- Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital
| | - Yuhua He
- Department of Gastrointestinal Surgery, West China Hospital
| | - Lili Jiang
- Department of Gastrointestinal Surgery, West China Hospital
| | - Ka Li
- West China School of Nursing, Sichuan University, Chengdu 610041, PR China
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Yoon S, Park J, Lee H, Min A. Influence of Partnerships with Nurses and Social Support on Readiness for Discharge among Mothers of Premature Infants. CHILD HEALTH NURSING RESEARCH 2019; 25:417-424. [PMID: 35004433 PMCID: PMC8650988 DOI: 10.4094/chnr.2019.25.4.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/29/2023] Open
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Factors and post-discharge outcomes associated with patients’ readiness for discharge from the emergency medicine ward: A prospective study. Int Emerg Nurs 2019; 46:100773. [DOI: 10.1016/j.ienj.2019.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/12/2019] [Accepted: 04/25/2019] [Indexed: 01/06/2023]
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Qiu C, Feng X, Zeng J, Luo H, Lai Z. Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: A cross-sectional study. Indian J Ophthalmol 2019; 67:612-617. [PMID: 31007219 PMCID: PMC6498919 DOI: 10.4103/ijo.ijo_1116_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose: To investigate the quality of discharge teaching, readiness for hospital discharge (RHD), and post-discharge outcomes (PDO) of cataract patients in a day ward and to explore the relationships among these three variables. Methods: This cross-sectional study used an opportunistic sample from the ophthalmic day ward in a general hospital in Sichuan province, China. Data were collected using four questionnaires. Results: The total average score on the Quality of Discharge Teaching Scale was 192.95, and the dimension with the lowest score was “guidance obtained practically.” The total average score on the Readiness for Hospital Discharge Scale was 175.51, and the dimension with the lowest score was “knowledge of disease.” The total average score on the Post-Discharge Outcome Questionnaire was 77.08, and the four dimensions with the lowest scores were “compliance behaviors,” “avoiding excessive use of eye,” “avoiding strenuous exercise,” and “regular check-up.” Pearson correlation coefficients indicated low to moderate correlations between discharge teaching quality and PDO (0.245, P < 0.01), RHD and PDO (0.271, P < 0.01), and discharge teaching quality and PDO (0.559, P < 0.01). Conclusion: The quality of discharge teaching among cataract patients who underwent day surgery was relatively high, and patient preparation for discharge and PDO were good. However, medical staff should focus more attention on patients’ individualized needs for discharge teaching while emphasizing the importance of compliance behavior.
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Affiliation(s)
- Chujin Qiu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xianqiong Feng
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Jihong Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmei Luo
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhifeng Lai
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Nurhayati N, Songwathana P, Vachprasit R. Surgical patients' experiences of readiness for hospital discharge and perceived quality of discharge teaching in acute care hospitals. J Clin Nurs 2019; 28:1728-1736. [PMID: 30589480 DOI: 10.1111/jocn.14764] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/15/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the level of perception of the quality of discharge teaching and its associations with the readiness for hospital discharge among surgical patients in acute care hospitals. BACKGROUND Discharge teaching is a primary strategy to facilitate patients' readiness for hospital discharge. The extent to which the surgical ward was perceived as providing patient-focused education when discharged has never been explored. Its impact on a patient's readiness is also unknown in the Indonesian context. DESIGN A correlational descriptive study was used to collect data from four hospitals in Indonesia. METHODS Ninety-six surgical patients who were in the discharge process enrolled in this study. The demographic form, the quality of discharge teaching scale (QDTS) and the readiness for hospital discharge scale (RHDS) were utilised for data collection. Data were collected from January-February 2018. Descriptive statistics and Spearman rank-order correlation were applied for data analysis. RESULTS The discharge teaching quality was perceived as being at a low level. The readiness for hospital discharge was reported to be at a moderate level. Overall, the discharge teaching quality was not statistically associated with the patients' readiness. However, positive correlations were found in QDTS and RHDS subscales such as content received and delivery, knowledge, coping ability and expected support. Patient's readiness for hospital discharge was also greater for those who had a caregiver, a short hospital stay, a health insurance and occupation. CONCLUSIONS Surgical patients perceived a low quality of discharge teaching, which may decrease their readiness for hospital discharge. RELEVANCE TO CLINICAL PRACTICE This study provides baseline information reflecting the patient learning needs in discharge preparation to guide surgical nurses for improving the discharge teaching quality and enhancing the patients' readiness for hospital discharge.
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Affiliation(s)
| | - Praneed Songwathana
- Faculty of Nursing, Adult and Elderly Nursing Department, Prince of Songkla University, Hat Yai, Thailand
| | - Ratjai Vachprasit
- Faculty of Nursing, Adult and Elderly Nursing Department, Prince of Songkla University, Hat Yai, Thailand
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Mabire C, Bachnick S, Ausserhofer D, Simon M. Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: A cross-sectional study. Int J Nurs Stud 2018; 90:13-20. [PMID: 30522054 DOI: 10.1016/j.ijnurstu.2018.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/13/2018] [Accepted: 09/28/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nursing discharge preparation is vital to successful hospital-to-home transitions. However, despite a wealth of evidence on its effectiveness, little is known of the structure- and process-related factors that facilitate or impede its use in clinical practice. Specifically, the associations between unit size and type, leadership support, skill mix, staffing, nurse and patient characteristics, discharge teaching and patient readiness for discharge have rarely been studied. OBJECTIVES This study aimed to explore the associations between structure-individual characteristics (i.e., unit, nurse and patient characteristics) and process-related (i.e., teaching of self-care and symptom management) factors and patient readiness for hospital discharge. DESIGN A secondary data analysis of the multicentre observational "Matching Registered Nurse services with changing care demands (MatchRN)" study. SETTING AND PERIOD Data were collected between September 2015 and January 2016 on 123 surgical, medical and mixed units in 23 Swiss acute care hospitals. PARTICIPANTS A total of 1833 registered nurses and 1755 patients were included in the analyses. METHODS Structure-, process- and patient readiness-related hospital discharge variables were assessed using validated items either from existing instruments or self-developed. Multilevel mixed-effects logistic regression was used to test associations. RESULTS Fewer than half of the patients hospitalized (47.8%) reported readiness for hospital discharge. Fifty-eight percent reported receiving discharge preparation interventions for self-care and 30% for symptom management. Patients' readiness for hospital discharge was significantly lower in larger units (β = -0.001; 95% confidence interval (CI) = -0.002 to -0.001) and on medical units (β = -0.44; 95% CI = -0.70 to -0.19). Higher nurses' experience (β = .004; 95% CI = 0.001 to 0.01), better patient self-reported health (β = -0.11; 95% CI = -0.17 to -0.05), higher patient ratings of self-care teaching (β = 1.33; 95% CI = 1.07-1.59) and symptom management teaching (β = 0.79; 95% CI = 0.52-1.06) were significantly associated with greater patient readiness for hospital discharge. CONCLUSIONS Patient readiness for hospital discharge is associated with process- and structure-related factors. Our findings suggest that, for successful uptake in clinical practice, the development and implementation of effective discharge preparation programs should consider the structural context, i.e., patient population, unit size, and experience of nurses within the team. Further research, using a more accurate measure of patient readiness for hospital discharge, is needed to test associations with the nurse work environment and staffing.
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Affiliation(s)
- Cedric Mabire
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne, Lausanne University Hospital, SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Stefanie Bachnick
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Claudiana College of Health-Care Professions, Lorenz-Böhler-Straße 13, 39100 Bolzano Italy
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Inselspital Bern University Hospital, Nursing Research Unit, 3010 Bern, Switzerland
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Topaz M, Trifilio M, Maloney D, Bar‐Bachar O, Bowles KH. Improving patient prioritization during hospital‐homecare transition: A pilot study of a clinical decision support tool. Res Nurs Health 2018; 41:440-447. [DOI: 10.1002/nur.21907] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Maxim Topaz
- Faculty of Social Welfare and Health Sciences, School of NursingUniversity of HaifaHaifaIsrael
- Brigham and Women's Health HospitalBostonMassachusetts
| | | | | | - Ofrit Bar‐Bachar
- Faculty of Social Welfare and Health Sciences, School of NursingUniversity of HaifaHaifaIsrael
| | - Kathryn H. Bowles
- Visiting Nurse Service of New YorkNew YorkNew York
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvania
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Kaya S, Sain Guven G, Aydan S, Kar A, Teleş M, Yıldız A, Koca GŞ, Kartal N, Korku C, Ürek D, Demir İB, Toka O. Patients’ readiness for discharge: Predictors and effects on unplanned readmissions, emergency department visits and death. J Nurs Manag 2018; 26:707-716. [DOI: 10.1111/jonm.12605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sıdıka Kaya
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Gulay Sain Guven
- Faculty of Medicine; Department of General Internal Medicine; Hacettepe University; Ankara Turkey
| | - Seda Aydan
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Ahmet Kar
- Faculty of Health Sciences; Department of Health Care Management; Kırıkkale University; Kırıkkale Turkey
| | - Mesut Teleş
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Ahmet Yıldız
- Vocational School of Health Services; Program of Health Institutions Management; Batman University; Batman Turkey
| | - Gülsüm Ş. Koca
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Nazan Kartal
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Cahit Korku
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Duygu Ürek
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - İpek Bilgin Demir
- Faculty of Economics and Administrative Sciences; Department of Health Care Management; Hacettepe University; Ankara Turkey
| | - Onur Toka
- Faculty of Science; Department of Statistics; Hacettepe University; Ankara Turkey
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Galvin EC, Wills T, Coffey A. Readiness for hospital discharge: A concept analysis. J Adv Nurs 2017; 73:2547-2557. [PMID: 28440958 DOI: 10.1111/jan.13324] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 12/01/2022]
Abstract
AIM To report on an analysis on the concept of 'readiness for hospital discharge'. BACKGROUND No uniform operational definition of 'readiness for hospital discharge' exists in the literature; therefore, a concept analysis is required to clarify the concept and identify an up-to-date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research. DESIGN Literature review and concept analysis. METHOD A review of literature was conducted in 2016. Databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied. RESULTS Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to 'readiness for hospital discharge' were extracted from the literature: physical stability, adequate support, psychological ability, and adequate information and knowledge. CONCLUSION This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist healthcare professionals to recognize, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital.
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Affiliation(s)
| | - Teresa Wills
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alice Coffey
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Experiences of Older Adult Trauma Patients Discharged Home From a Level I Trauma Center. J Trauma Nurs 2017; 24:182-192. [DOI: 10.1097/jtn.0000000000000288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Copeland LA, Graham LA, Richman JS, Rosen AK, Mull HJ, Burns EA, Whittle J, Itani KMF, Hawn MT. A study to reduce readmissions after surgery in the Veterans Health Administration: design and methodology. BMC Health Serv Res 2017; 17:198. [PMID: 28288681 PMCID: PMC5348767 DOI: 10.1186/s12913-017-2134-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/04/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability. METHODS Harnessing the rich VA enterprise data, predictive readmission models are being developed in data from patients who underwent surgical procedures within the VA 2007-2012. Prospective assessment of psychosocial determinants of readmission including patient self-efficacy, cognitive, affective and caregiver status are being obtained from a cohort having colorectal, thoracic or vascular procedures at four VA hospitals in 2015-2017. Using these two data sources, ISQ-R will develop readmission categories and validate the readmission risk prediction model. A modified Delphi process will convene surgeons, non-surgeon clinicians and quality improvement nurses to rank proposed readmission categories vis-à-vis potential preventability. DISCUSSION ISQ-R will identify promising avenues for interventions to facilitate improvements in surgical quality, informing specifications for surgical workflow managers seeking to improve care and reduce cost. ISQ-R will work with Veterans Affairs Surgical Quality Improvement Program (VASQIP) to recommend potential new elements VASQIP might collect to monitor surgical complications and readmissions which might be preventable and ultimately improve surgical care.
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Affiliation(s)
- Laurel A Copeland
- Veterans Affairs: VA Central Western Massachusetts Healthcare System, Leeds, MA, USA. .,Texas A & M Health Science Center, College of Medicine, Temple, TX, USA. .,Department of Psychiatry, UT Health Science Center San Antonio, San Antonio, TX, USA.
| | | | | | - Amy K Rosen
- Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Hillary J Mull
- Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Edith A Burns
- Veterans Affairs, Milwaukee VAMC, Milwaukee, WI, USA
| | - Jeff Whittle
- Veterans Affairs, Milwaukee VAMC, Milwaukee, WI, USA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Harvard School of Medicine, Cambridge, MA, USA
| | - Mary T Hawn
- Veterans Affairs, Palo Alto VAMC, Palo Alto, CA, USA.,Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
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Malagon-Maldonado G, Connelly CD, Bush RA. Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice. Worldviews Evid Based Nurs 2017; 14:118-127. [PMID: 28226190 DOI: 10.1111/wvn.12208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. AIMS The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. METHODS The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. RESULTS Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. LINKING EVIDENCE TO ACTION The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.
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Affiliation(s)
- Gabriella Malagon-Maldonado
- Director of Education, Research, and Professional Practice, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Cynthia D Connelly
- Director of Nursing Research and Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, CA, USA
| | - Ruth A Bush
- Clinical Associate Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, CA, USA
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Shuman C, Liu J, Montie M, Galinato JG, Todd MA, Hegstad M, Titler M. Patient perceptions and experiences with falls during hospitalization and after discharge. Appl Nurs Res 2016; 31:79-85. [PMID: 27397823 DOI: 10.1016/j.apnr.2016.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to describe hospitalized older adults' (> 60years) perceptions about (1) their fall risks while hospitalized; (2) fall prevention interventions received while hospitalized; and (3) fall prevention discharge instructions. BACKGROUND Little is known about hospitalized older adults' perceptions regarding fall prevention interventions received during hospitalization and fall prevention discharge instructions. METHODS This is a prospective, exploratory study using qualitative methods. RESULTS This paper reports qualitative findings of patients' perspectives on fall prevention interventions during hospitalization and at discharge. Eight major themes supported by multiple minor themes emerged: overall perceptions of falling; overall perceptions of fall prevention interventions while hospitalized; "telling" fall prevention; "doing" fall prevention; effectiveness of fall prevention strategies; personal fall prevention strategies; fall-related discharge instructions; and most effective fall-related discharge instructions. CONCLUSIONS Findings suggest healthcare providers need to more fully engage patients and families in understanding fall prevention interventions and factors contributing to falls during hospitalization and at discharge.
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Affiliation(s)
- Clayton Shuman
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
| | - Jia Liu
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
| | - Mary Montie
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA.
| | | | - Molly A Todd
- St. Joseph Mercy-Ann Arbor, Ann Arbor, MI 48106, USA
| | | | - Marita Titler
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
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Lau D, Padwal RS, Majumdar SR, Pederson JL, Belga S, Kahlon S, Fradette M, Boyko D, McAlister FA. Patient-Reported Discharge Readiness and 30-Day Risk of Readmission or Death: A Prospective Cohort Study. Am J Med 2016; 129:89-95. [PMID: 26344631 DOI: 10.1016/j.amjmed.2015.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early readmissions to hospital after discharge are common, and clinicians cannot accurately predict their occurrence. We examined whether patients who feel unready at the time of discharge have increased readmissions or death within 30 days. METHODS This was a prospective cohort study of adult patients discharged home from 2 tertiary care hospitals in Edmonton, Alberta, Canada, between October 2013 and November 2014. Patient-reported discharge readiness was measured with an 11-point Likert response scale, with scores <7 indicating subjective unreadiness. The primary outcome was readmission or death within 30 days. Logistic regression models were adjusted for age, sex, and a validated risk prediction score for postdischarge events (LACE index). RESULTS Of 495 patients (mean age 62 years, 51% female, mean Charlson comorbidity index 2.8), 112 (23%) reported being unready for discharge. Risk factors for being unready at discharge were cognitive impairment (mild vs none), low satisfaction with health care services, depression, lower education, previous hospital admissions (12 months), and persistent symptoms or disability. At 30 days, 85 patients (17%) had been readmitted or died, with no significant difference between patients who felt unready or ready (15% vs 18%, adjusted odds ratio 0.84, 95% confidence interval 0.46-1.54, P = .59). CONCLUSIONS Although nearly one-quarter of hospitalized medical patients reported being unready at the time of discharge, they did not experience any higher risk of readmission or death in the first 30 days after discharge, compared with patients who felt ready for discharge.
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Affiliation(s)
- Darren Lau
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sumit R Majumdar
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jenelle L Pederson
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Belga
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sharry Kahlon
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Miriam Fradette
- Epidemiology Coordinating and Research Centre (EPICORE), University of Alberta, Edmonton, Alberta, Canada
| | - Debbie Boyko
- Epidemiology Coordinating and Research Centre (EPICORE), University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada; Patient Health Outcomes Research and Clinical Effectiveness Unit (PHORCE), University of Alberta, Edmonton, Alberta, Canada.
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Abstract
BACKGROUND A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients' needs and preferences during care transition, professionals must understand their experiences. OBJECTIVE The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services. METHODS The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals' experiences during care transition. RESULTS Two complementary themes emerged during the analysis: "Participation depends on being invited to plan the care transition" and "Managing continuity of care represents a complex and challenging process". DISCUSSION Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important resources, which illustrate the importance of making their voice heard. Older patients are therefore likely to benefit from more intensive support. A tailored, patient-centered follow-up of each patient is suggested to ensure that patient preferences and continuity of care to adhere to the new situation.
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Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway
- Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway
- Correspondence: Else Cathrine Rustad, Stord/Haugesund University College, Klingenbergvegen 8, N-5414 Stord, Norway, Email
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Seiger Cronfalk
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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LaManna JB, Bushy A, Norris AE, Chase SK. Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed With Diabetes. DIABETES EDUCATOR 2015; 42:72-86. [DOI: 10.1177/0145721715620020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this study was to identify factors affecting early and intermediate hospital-to home transition outcomes of older adults with preexisting diabetes mellitus. Methods A mixed-methods design was used. A sample of 96 hospitalized older adults with a prior diagnosis of diabetes were recruited within 4 hours of discharge. Data reflective of general health status, diabetes status, perceived discharge readiness (Readiness for Hospital Discharge Scale), hospitalization, and anticipated postdischarge support were gathered upon enrollment. Transition outcome data including unplanned care encounter occurrences, perceived transition quality (Care Transition Measure-15), and postdischarge difficulty (scale and free responses to the Post-Discharge Coping Difficulty Scale [PDCDS]) were obtained by telephone interview 7 and 30 days after discharge. Three unique, dichotomous variables were created from recurrent subthemes that emerged during content analysis of free-response data and were used in statistical testing. Binary logistic regression was performed to identify predictive factors for an unplanned care encounter within 30 days of discharge. Results Multimorbidity was prevalent in participants. Difficulties managing medications, blood glucose, and chronic illnesses other than diabetes were common problems. Higher PDCDS scores 7 and 30 days following discharge and difficulty managing a nondiabetes chronic health problem were predictive of an unplanned care encounter within 30 days of discharge. Conclusions Multimorbidity complicates home recovery of older adults with diabetes. Diabetes adds complexity to hospital-to-home care transitions. Transition difficulties predict higher risk for an unplanned care encounter. More intensive follow-up of older adults with diabetes during the first month following discharge is recommended.
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Affiliation(s)
- Jacqueline B. LaManna
- University of Central Florida College of Nursing, Orlando, Florida (Dr LaManna, Dr Bushy)
- University of Miami School of Nursing and Health Studies, Miami, Florida (Dr Norris)
- University of Central Florida College of Nursing, Orlando, Florida (Dr Chase)
| | - Angeline Bushy
- University of Central Florida College of Nursing, Orlando, Florida (Dr LaManna, Dr Bushy)
- University of Miami School of Nursing and Health Studies, Miami, Florida (Dr Norris)
- University of Central Florida College of Nursing, Orlando, Florida (Dr Chase)
| | - Anne E. Norris
- University of Central Florida College of Nursing, Orlando, Florida (Dr LaManna, Dr Bushy)
- University of Miami School of Nursing and Health Studies, Miami, Florida (Dr Norris)
- University of Central Florida College of Nursing, Orlando, Florida (Dr Chase)
| | - Susan K. Chase
- University of Central Florida College of Nursing, Orlando, Florida (Dr LaManna, Dr Bushy)
- University of Miami School of Nursing and Health Studies, Miami, Florida (Dr Norris)
- University of Central Florida College of Nursing, Orlando, Florida (Dr Chase)
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Mabel Carrillo G, Sánchez Herrera B, Arias Rojas EM. Validation of an instrument to assess the homecare competency of the family caregiver of a person with chronic disease. INVESTIGACION Y EDUCACION EN ENFERMERIA 2015; 33:449-455. [PMID: 28569952 DOI: 10.17533/udea.iee.v33n3a08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 04/15/2015] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This work sought to develop, validate, and determine the reliability of an instrument on Competency in Homecare of the family caregiver of an individual with chronic disease. METHODOLOGY The test validation study was carried out in the following phases: 1) literature review; 2) analysis of results of programs to help family caregivers in Latin America; 3) exploration of the classification of nursing results (NOC) related to the family caregiver and discharge; 4) proposal of an instrument of care competence; and 5) psychometric tests: apparent validity with 25 family caregivers of individuals with chronic disease and six experts in the area; construct validity and reliability through internal consistency with 311 family caregivers of chronic patients. RESULTS The instrument on homecare competency of the family caregiver of an individual with chronic disease (CUIDAR, for the term in Spanish) has 60 items that inquire on six categories: knowledge, uniqueness, instrumentation, enjoyment of life, anticipation and relationships, and social interaction. The apparent validity evidences clarity, coherence, sufficiency, and relevance of the scale. With the factor analysis six components were obtained through the Varimax rotation in which most of the items are associated according to the categories proposed. The reliability (internal consistency) reported a Cronbach's alpha of 0.96. CONCLUSION The Homecare Competency instrument permits assessing the capacity of a family caregiver to care for an individual with chronic disease, proving valid and reliable for the Colombian context.
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Nursing discharge planning for older medical inpatients in Switzerland: A cross-sectional study. Geriatr Nurs 2015; 36:451-7. [DOI: 10.1016/j.gerinurse.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/01/2015] [Accepted: 07/04/2015] [Indexed: 11/24/2022]
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Mabire C, Lecerf T, Büla C, Morin D, Blanc G, Goulet C. Translation and psychometric evaluation of a French version of the Readiness for Hospital Discharge Scale. J Clin Nurs 2015. [DOI: 10.1111/jocn.12937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cedric Mabire
- University of Health Sciences (HESAV); Lausanne Switzerland
| | - Thierry Lecerf
- Faculty of Psychology and Educational Sciences; University of Geneva; Geneva Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation; University of Lausanne Hospital Centre - CHUV; Lausanne Switzerland
| | - Diane Morin
- Institute of Higher Education and Nursing Research; Lausanne University; Lausanne Switzerland
| | - Genevieve Blanc
- Institute of Nursing; Zurich University of Applied Sciences Winterthur; Winterthur Switzerland
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Mabire C, Coffey A, Weiss M. Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample. J Adv Nurs 2015. [DOI: 10.1111/jan.12731] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cédric Mabire
- University of Health Sciences (HESAV); Lausanne Switzerland
| | - Alice Coffey
- School of Nursing and Midwifery; University College Cork; Ireland
| | - Marianne Weiss
- Marquette University College of Nursing; Milwaukee Wisconsin USA
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