Parent Readiness for Hospital Discharge Scale: Psychometrics and Association With Postdischarge Outcomes

Psychometric properties of the Turkish version of the Readiness for Hospital Discharge Scale-Parent Form (Ped-RHDS)

BACKGROUND

An objective evaluation of parents' perceived readiness for the discharge of their child from hospital may aid in the prevention of readmission and rehospitalization. This study examined the validity and reliability of the Turkish version of the Readiness for Hospital Discharge Scale-Parent Form (Ped-RHDS) for children in Turkey.

METHODS

The parents of 160 children planned for discharge from the pediatric surgery and pediatric departments were included. Cronbach's α, exploratory factor, confirmatory factor, item-total correlation, and criterion validity analyses of the Turkish Ped-RHDS were performed.

RESULTS

The Turkish Ped-RHDS has 26 items in 5 factors explaining 52.212% of the total scale variance. The scale had a Cronbach's alpha of 0.842. In exploratory and confirmatory factor analyses, item factor loadings were higher than 0.30 and comparative fit and goodness of fit indices were 0.96 and 0.93, respectively. In criterion-based validity, total Ped-RHDS score weakly correlated with scores on the Post-Discharge Coping Difficulty Scale (r = -0.164; p = 0.039). Item-item total score correlations for the Turkish Ped-RHDS were between 0.329 and 0.532.

CONCLUSION

The Turkish Ped-RHDS is valid and reliable as a parent-reported instrument for the assessment of hospital discharge readiness in children and parents.

PRACTICE IMPLICATIONS

Healthcare professionals can use this assessment tool to measure parental and child discharge readiness before children are discharged from hospital. The Turkish Ped-RHDS should be integrated into discharge readiness assessment as standard practice in the discharge of pediatric patients.

The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery

BACKGROUND

The aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery.

METHODS

This study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention.

RESULTS

The results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001).

CONCLUSION

The H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery.

IMPLICATIONS TO PRACTICE

The results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.

Development and psychometric analysis of care needs scale for mothers of children with congenital heart disease

PURPOSE

This cross-sectional study aimed to create and evaluate a care needs scale for mothers of children with congenital heart disease (CHD) to determine its psychometric properties.

DESIGN AND METHODS

This methodological research was conducted with 155 mothers whose children were diagnosed with CHD and were treated at a university hospital. The study's methodology included scale development, specialist opinions, and a pilot test. Data analysis involved descriptive statistics, exploratory and confirmatory factor analyses, and reliability assessments.

RESULTS

The 11-item scale was created using component analysis, expert comments, and pilot testing. It was divided into two categories: Information Needs Regarding Disease and Treatment and Needs Regarding Care. The Exploratory Factor Analysis revealed a 2-factor structure, explaining 41.5% of the variance. Reliability analysis showed reliable dimensions, and Tukey's scalability test indicated the scale requires separate dimension evaluation. The model fit indices were obtained as CMIN/DF (72.751/41) = 1.774, GFI = 0.925, IFI = 0.923, TLI = 0.893, CFI = 0.920, RMSEA = 0.071, SRMR = 0.063. The Cronbach's alpha coefficient for subdimension 1 was 0.758, and for subdimension 2 was 0.678, indicating reliable dimensions.

CONCLUSION

The developed scale provides a valuable tool for assessing the care needs of mothers of children with CHD, contributing to enhancing maternal support programs in pediatric cardiology clinics.

PRACTICE IMPLICATIONS

Assessment of the care needs of mothers who have children with CHD is promising for the development of educational programs on this subject and to ensure the competence of mothers for care.

Research trends in readiness for hospital discharge between 2002 and 2021: A bibliometric analysis

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.

Community reintegration: Children with special healthcare needs in rural areas

PURPOSE

The purpose of this study was to gather descriptions from caregivers and providers of children with special healthcare needs (CSHCN) about their experiences with community reintegration. This study focused on three community support areas: the healthcare structure, community of support, and school systems. The research question was, "How do caregivers and providers of CSHCN describe reintegration into community-based systems?"

METHOD

This descriptive qualitative study used focus group design to interview caregivers and providers about their experiences. Data were analyzed using conventional content analysis with open coding, clustering into categories, and abstracting into themes.

RESULTS

Eight themes were found within three categories. 1. Planning life and caregiving while fighting for everything needed, 2. Deciding to seek help while living with stigma, shame, and fear, 3. Coping with caregiving while feeling isolated, stressed, and overwhelmed, 4. Arranging transportation while living far away, 5. Underwhelming support in community and school systems, 6. Managing finances and covering expenses, 7. Improving communication of complex needs, and 8. Building a community, increasing confidence, and providing hope.

CONCLUSION

Community reintegration was described by caregivers and providers as balancing responsibilities, securing resources, and facilitating collaboration, which offer guidance for future care.

IMPLICATIONS

Engaging in open dialogue structured by the themes can help nurses understand the unique needs of caregivers of CSHCN. Social policy reform focused on access to care, financial resources, and school support may reduce inequities, and additional research focused on community-based systems, coping, and caregiving may identify needs based on sociodemographics and existing resources.

Reliability and validity of the Chinese post-discharge coping difficulty scale-parent form in parents of premature infants: a multicenter cross-sectional study

Background

The measurement of the coping difficulties of parents of premature infants after discharge provides objective data for nurses to prepare infants for discharge. However, no Chinese scale has been developed to measure parents' coping difficulties after their premature infants are discharged.

Aim

To translate the parent version of the Post-Discharge Coping Difficulty Scale (Ped-PDCDS) from English to Chinese and test the reliability and validity of the Chinese version in parents of premature infants.

Methods

A multicenter cross-sectional study of 356 parents of premature infants was conducted. The scale was symmetrically translated. Validity was evaluated in terms of content, construct, discriminant, and convergent validities. Reliability was assessed in terms of internal consistency, split-half reliability, and test-retest reliability.

Results

The Chinese Ped-PDCDS finally contained 11 items. Exploratory and confirmatory factor analyses results showed that the Chinese Ped-PDCDS had three dimensions, and the convergent and discriminant validities of the scale was satisfactory. The overall reliability, split-half reliability, and test-retest reliability of the scale was 0.85, 0.92, and 0.84, respectively.

Conclusion

The Chinese Ped-PDCDS has adequate psychometric properties, and is an easy and appropriate instrument for measuring parents' difficulty in coping with premature infants.

Family Integrated Care in Uganda: a feasibility study

OBJECTIVE

To determine the feasibility of adapting Family Integrated Care to a neonatal hospital unit in a low-income country.

DESIGN

Single-centre, pre/post-pilot study of an adapted Family Integrated Care programme in Uganda (UFICare).

SETTING

Special Care Nursery at a Ugandan hospital.

PATIENTS

Singleton, inborn neonates with birth weight ≥2 kg.

INTERVENTIONS

As part of UFICare, mothers weighed their infant daily, assessed for severe illness ('danger signs') twice daily and tracked feeds.

MAIN OUTCOME MEASURES

Feasibility outcomes included maternal proficiency and completion of monitoring tasks. Secondary outcomes included maternal stress, discharge readiness and post-discharge healthcare seeking.

RESULTS

Fifty-three mother-infant dyads and 51 mother-infant dyads were included in the baseline and intervention groups, respectively. Most mothers were proficient in the tasks 2-4 days after training (weigh 43 of 51; assess danger signs 49 of 51; track feeds 49 of 51). Mothers documented their danger sign assessments 82% (IQR 71-100) of the expected times and documented feeds 83% (IQR 71-100) of hospital days. In the baseline group, nurses weighed babies 29% (IQR 18-50) of hospitalised days, while UFICare mothers weighed their babies 71% (IQR 57-80) of hospitalised days (p<0.001). UFICare mothers had higher Readiness for Discharge scores compared with the baseline group (baseline 6.8; UFICare 7.9; p<0.001). There was no difference in maternal stress scores or post-discharge healthcare seeking.

CONCLUSIONS

Ugandan mothers can collaborate in the medical care of their hospitalised infant. By performing tasks identified as important for infant care, mothers felt more prepared to care for their infant at discharge.

Are Parent Discharge Readiness Scores Effective for the Congenital Heart Disease Patients After Cardiac Surgery?

OBJECTIVE

To assess discharge readiness and clinical engagement post-discharge in familes of children undergoing congenital heart surgery (CHS).

STUDY DESIGN

This prospective cross-sectional study was performed at a major tertiary pediatric cardiac referral center. Eligible parents and caregivers completed a discharge readiness tool, the Readiness for Hospital Discharge Scale for Parents of Hospitalized Children (PedRHDS), via online survey on the day of discharge. Clinical engagement data included subsequent phone calls, clinic visits, emergency department (ED) visits, and hospital readmissions. PedRHDS scores were measured as follows: Very High (9-10), High (8-8.9), Moderate (7-7.9), and Low (<7). Descriptive statistics were used to describe demographic data.

RESULTS

128 families enrolled between April and December 2021. Parent discharge readiness scores ranged from 'High' to 'Very High.' Families with lower socioeconomic status and younger patients (especially single ventricle infants or "interstage") had a higher proportion of clinic visits, ED visits, and hospital readmissions within 30-days post-discharge compared with other groups.

CONCLUSIONS

Discharge readiness scores were not associated with clinical engagement. We identified vulnerable populations as evidenced by a higher frequency of clinical engagement in the immediate post-operative period, particularly younger patients and first time surgeries. While these visits may be appropriate, novel programs could enhance education and emotional support to prevent delay in seeking care or creating excessive stress and anxiety after discharge.

Nurses' perception of readiness to care for parents of children with special healthcare needs

PURPOSE

To describe pediatric nurses' perception of readiness to care for parents of children with special healthcare needs.

DESIGN AND METHODS

This cross-sectional, exploratory study surveyed 56 pediatric nurses from a large tertiary care center in Appalachia. Participants completed an anonymous electronic survey aimed at evaluating perception of discharge preparation and readiness to care. Data analysis included descriptive statistics and Chi square comparisons.

RESULTS

The majority of participants (80%) reported spending 12 h or less preparing parents for discharge. The domains rated lowest on readiness to care included financial, psychological, and emotional. Participants anticipate parents spending an average of 13.9 h a day serving as the child's primary caregiver in the home.

CONCLUSIONS

Subjective, 'unseen' domains of readiness are often under-assessed and evaluated. Parents are often discharged with limited preparation to assume around-the-clock care for a child with special healthcare needs, specifically related to their holistic health and wellbeing.

PRACTICE IMPLICATIONS

Standardization of discharge preparation and readiness evaluation should focus on overall parent preparedness, including financial, psychological, and emotional domains. Discharge preparation should begin at the time of admission to familiarize parents with care. Clear, frequent communication should be used to emphasize realistic expectations and assess unique needs. Provision of accessible community-based resources should be given early to better equip parents with supportive services once home.

Implementing Evidence-Informed Discharge Preparedness Tools in the NICU: Parents' Perceptions

BACKGROUND

Few studies address preparing parents of neonatal intensive care unit (NICU) infants for infant discharge. Inadequate or ineffective parental preparedness for discharge can result in preventable emergency department and primary care visits. Parents' perceptions are needed to inform development and implementation of effective educational tools to improve parent discharge preparedness in the NICU.

PURPOSE

To describe the perceptions of parents of recently discharged NICU infants regarding discharge preparedness and implementation of the My Flight Plan for Home parent discharge preparedness tool.

METHODS

We used a qualitative descriptive design to collect individual interview data from 15 parents with infants discharged from a level 4 NICU in the Midwest. Individual interviews were conducted using a semistructured guide and were audio-recorded, transcribed verbatim, and thematically analyzed using the constant comparative method.

RESULTS

We identified 5 major themes: (1) family dynamics; (2) parenting in the NICU; (3) discharge preparedness; (4) engaging parents in infant care; and (5) implementation recommendations for the My Flight Plan for Home tool. Minor themes supported each of the major themes.

IMPLICATIONS FOR PRACTICE

To improve parents' confidence in caring for their infant after discharge, parents suggest nurses must engage parents in discharge education and infant care shortly following NICU admission and use parent-centered discharge preparedness tools.

IMPLICATIONS FOR RESEARCH

Future studies are needed to develop and test parent-tailored strategies for implementing parent discharge preparedness tools in the NICU.

Unreadiness for hospital discharge predicts readmission among cardiac patients: results from the national DenHeart survey

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.

Parent Perspectives on Short-Term Recovery After Spinal Fusion Surgery in Children With Neuromuscular Scoliosis

Family perspectives on short-term recovery after spinal fusion for neuromuscular scoliosis are essential for improving patient outcomes. Semistructured interviews were conducted with 18 families of children within 3 months after spinal fusion performed August 2017 to January 2019 at a children's hospital. Interviews were recorded, transcribed, and coded line-by-line by 2 independent reviewers using grounded theory to identify themes. Five themes emerged among families when reflecting back on the postoperative recovery: (1) communicating and making shared decisions regarding postoperative care in a patient- and family-centered manner, (2) setting hospital discharge goals and being ready for discharge, (3) planning for transportation from hospital to home, (4) acquiring supports for caregiving at home after discharge, and (5) anticipating a long recovery at home. Important family perceptions were elicited about the recovery of children from spinal fusion for neuromuscular scoliosis that will inform better perioperative planning for clinicians, future patients, and their families.

Adaptation of the parent readiness for hospital discharge scale with mothers of preterm infants discharged from the neonatal intensive care unit

AIMS AND OBJECTIVES

To evaluate the psychometric properties of a new Persian translation of the Readiness for Hospital Discharge Scale.

BACKGROUND

Globally, one in 10 newborns are born preterm and many require care in a neonatal intensive care unit (NICU). A primary role of NICU nurses is to assure parents are well prepared to take their newborns home from the hospital. Assessment of parent perception of discharge readiness provides important input into discharge decisions. The availability of reliable and valid instruments tested within the geographical and cultural context is needed for a comprehensive assessment of predischarge readiness, so that parent needs can be identified and the necessary interventions designed and implemented.

DESIGN

This psychometrics study included a convenience sample of 200 mothers with preterm infants being discharged from the NICU of Shahid Sadoughi Hospital in Yazd, Iran. The original 29-item version of the Readiness for Hospital Discharge Scale-Parent questionnaire was translated into Persian using the standard forward-backward method. Face, content and construct validity (principal components analysis), and reliability (internal consistency-Cronbach's alpha) were assessed. Methods followed STROBE criteria as applicable (see Appendix S1).

RESULTS

The content validity index and content validity ratio were both 0.93. Construct validity testing identified 6 factors (mother and infant physical-psychological readiness, expected support, knowledge of future events and care, knowledge of infant personal care, pain and therapeutic interventions). Using Cronbach's alpha coefficient, the reliability of the whole instrument was estimated to be 0.87.

CONCLUSION

The Persian Readiness for Hospital Discharge-Parental Form for use with mothers of preterm infants being discharged from an Iranian NICU has acceptable validity and reliability.

RELEVANCE TO PRACTICE

This tool can be used before discharge to determine the needs of mothers and design the necessary measures to improve quality of discharge care.

Translation, Adaptation and Psychometric Validation of the Indonesian Version of the Readiness for Hospital Discharge Scale for Parents of Low Birth Weight Infants

PURPOSE

Parental readiness is a requirement for discharge of the high-risk infant from the hospital. Currently, in Indonesia, there are no standard tools to measure parental readiness according to parents' perceptions. This study aimed to undertake cross-cultural adaptation and psychometric validation of the original version (English) of the Readiness for Hospital Discharge Scale (RHDS)-Parent into Bahasa Indonesia.

DESIGN AND METHODS

The cross-cultural adaptation was comprised of seven steps: forward translation, forward translation review, blind-back translation, back translation review, pilot testing of the pre-final version with mothers of low birth weight (LBW) infants, expert panel for conceptual and content equivalence, and initial psychometric testing. In the fifth and sixth steps, content validity index was estimated. In the seventh step, exploratory factor analysis (EFA) and internal consistency reliability were conducted. In total, 146 mothers of LBW infants were included in the psychometric testing using convenience sampling.

RESULTS

The 22 item Bahasa-RHDS-Parent emerged in a four-factor structure evident from EFA. This version has good reliability with Cronbach alpha values for knowledge and coping ability (0.92), physical-emotional readiness (0.89), pain and power (0.83), expected support (0.80) and 0.90 across the total Bahasa-RHDS-Parent.

CONCLUSION

The Bahasa-RHDS-Parent presents good cross-cultural adaptation and initial psychometric properties for assessing parental readiness in parents with LBW infants before hospital discharge.

PRACTICE IMPLICATIONS

This questionnaire can be used by nurses to measure readiness for discharge of parents of low birthweight babies. Further testing is needed with a larger sample and parents of children of other ages and conditions for instrument improvement.

The effects of a transitional care program on discharge readiness, transitional care quality, health services utilization and satisfaction among Chinese kidney transplant recipients: A randomized controlled trial

BACKGROUND

Kidney transplantation is the major treatment for end-stage renal disease (ESRD). However, kidney transplant recipients (KTRs) face severe challenges during the transition period from hospital discharge to home, increasing the risk of early hospital readmission (EHR) and affecting patient safety. Nevertheless, knowledge of effective transitional care for KTRs is limited in China.

OBJECTIVE

To evaluate the effectiveness of an innovative transitional care program in improving discharge readiness, transitional care quality, health services utilization and patient satisfaction among KTRs in China.

DESIGN

A prospective randomized controlled trial.

SETTINGS AND PARTICIPANTS

Patients admitted to undergo kidney transplantation were recruited in a general tertiary hospital in Chengdu, China.

METHODS

A total of 220 eligible patients were recruited and randomly assigned to the intervention and control groups. Participants in the intervention group received a transitional care intervention developed by the research team, including a risk assessment for early readmission, health education from admission to predischarge, individualized discharge planning, and a telephone follow-up once per week for one month and WeChat follow-up postdischarge. The control group received routine care of comparable length and follow-up contact. A trained research assistant collected all patients' baseline data on admission (T0), evaluated the discharge readiness (by the Readiness for Hospital Discharge Scale) on the day of discharge (T1), collected data on transitional care quality (by the Care Transition Measure-15) and patients' satisfaction with transitional care services (by a self-developed patient satisfaction scale) on the 30th day postdischarge (T2), and collected data on hospital readmission, unscheduled outpatient department visits, and emergency room visits on the 30th and 90th days (by a self-developed health services utilization record table) (T3) postdischarge. Intervention effects were analyzed using independent samples t-tests, Wilcoxon-Mann-Whitney U tests, Chi-square tests or Fisher's exact test.

RESULTS

Compared with the control group, the intervention group showed significantly better discharge readiness (personal status, P<0.001; knowledge, P = 0.010; coping ability, P<0.001; expected support, P = 0.007; total score, P<0.001), better transitional care quality (importance of preferences, P<0.001; management preparation, P<0.001; critical understanding, P = 0.003; written and understandable care plan, P = 0.012; total score, P<0.001), lower readmission rate at T2 (P = 0.033) and at T3 (P = 0.013), lower emergency room visit rate at T3 (P = 0.014), and better satisfaction with transitional care services (P<0.001).

CONCLUSIONS

This study provides evidence that an innovative transitional care program is effective in promoting KTRs' discharge readiness, transitional care quality, reducing hospital readmission and emergency room visits, and improving their satisfaction with transitional care services.

TRIAL REGISTRATION

Clinical Trials ChiCTR1800014971.