Parent Readiness for Their Preterm Infant's Neonatal Intensive Care Unit Discharge

Relationships Between Quality of Discharge Teaching, Readiness for Hospital Discharge, Self-Efficacy and Self-Management in Patients With First-Episode Stroke: A Cross-Sectional Study

AIMS

The study investigated the influence of quality of discharge teaching (QDT) on readiness for hospital discharge (RHD) and pathways involved in patients with first-episode stroke, aiming to provide a theoretical framework for enhancing RHD levels and reducing readmission rates.

DESIGN

Cross-sectional study.

METHODS

A total of 372 inpatients completed the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Chronic Disease Self-efficacy Scale and Southampton Stroke Self-Management Questionnaire. Structural equation modelling and Pearson's correlation analysis were utilised to elucidate relationships and action pathways among these variables.

RESULTS

The correlation analysis demonstrated significant positive pairwise correlations between QDT, RHD, self-efficacy and self-management (r = 0.376-0.678, p < 0.01). The final model exhibited a good fit with the following indices: χ2/df = 3.286, RMSEA = 0.078, SRMR = 0.0303, GFI = 0.984, AGFI = 0.926, CFI = 0.991 and TLI = 0.970. The impact of QDT on RHD in patients with first-episode stroke was observed through one direct and three indirect pathways: (1) QDT exerted a direct influence on RHD (p < 0.001); (2) QDT indirectly influenced RHD via self-efficacy (p < 0.001); (3) QDT indirectly affected RHD through self-management (p < 0.001); and (4) QDT had an indirect effect on RHD via both self-efficacy and self-management (p < 0.05).

CONCLUSION

QDT was found to directly influence RHD in patients with first-episode stroke and also exerted indirect effects through self-efficacy and self-management, either independently or in combination. Early screening of RHD levels in patients before discharge is recommended, along with the enhancement of QDT through the development of tailored guidance plans according to different disease stages, ultimately improving RHD levels and facilitating a safer transition from hospital to home or community.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should assess both QDT and RHD levels to provide targeted interventions. The establishment of transitional care teams and implementation of long-term poststroke management are essential for reducing stroke recurrence and mortality rates.

Exploring the factors affecting the readiness for hospital discharge after total knee arthroplasty: A structural equation model approach

AIM

To investigate the factors that influence readiness for hospital discharge in Chinese patients after total knee arthroplasty and to identify priorities for nursing interventions.

DESIGN

A cross-sectional study.

METHODS

From January to August 2022, data were collected from 339 patients at two tertiary A-level hospitals in Jinan, Shandong Province. SPSS 26.0 and Mplus 8.3 software were used for statistical analysis.

RESULTS

Results from multiple linear regression showed that patients' age, residence status, education level, knee pain during sleep, quality of discharge teaching, self-efficacy for rehabilitation, pain control knowledge, and social support were factors influencing their readiness for hospital discharge. The results of the structural equation model had shown that there were also indirect effects of the education level, knee pain during sleep, quality of discharge teaching, and pain control knowledge.

CONCLUSION

Patients' readiness for hospital discharge needs further improvement, hence physicians and nurses should judiciously allocate medical resources and concentrate their efforts on high-risk groups characterized by low readiness for hospital discharge.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study underscores the importance of physicians and nurses prioritizing key factors such as age, residency status, education level, and social support in total knee arthroplasty patients to enhance their readiness for hospital discharge. By implementing targeted discharge planning, effective pain management, and comprehensive rehabilitation education, healthcare providers can improve patient outcomes.

IMPACT

This study identified key factors influencing readiness for hospital discharge in total knee arthroplasty patients, guiding targeted nursing interventions to improve post-operative care.

REPORTING METHOD

STROBE.

PATIENT OR PUBLIC CONTRIBUTION

The participants recruited for this study were actively engaged in the data collection process.

Parental readiness for hospital discharge and the relationship with growth and development of infant in China

PURPOSE

This study aimed to evaluate the associations between parental readiness for discharge and neonatal growth.

DESIGN AND METHODS

This cross-sectional study included 549 newborns whose parents filled out the Newborn-Parental Readiness for Discharge Scale (N-PRDS).Additionally, data on birth weight, length, and head circumference were collected.The total N-PRDS scores were divided into three levels in terms of readiness: low, intermediate, and high readiness. Parents and infants were followed up 42 days after the birth, and the weight, length, and head circumference of the newborns were measured at the hospital.

RESULTS

A total of 306 data were obtained. The generalized linear mixed model (GLMM) showed that time and parental readiness had an interaction effect on the weight, length and head circumference of infants. The difference in weight between infants under the high and low readiness conditions at 42 days increased by 0.357 kg compared to the difference at birth. The difference in length between high readiness infants and low readiness infants at 42 days increased by 2.155 cm compared to the difference at birth. The difference between the infants' head circumference under the high and low readiness conditions at 42 days was 0.873 cm higher than that at birth.

CONCLUSIONS

High readiness for discharge could promote an increase in infant weight, length,and head circumference at 42 days after birth.

PRACTICE IMPLICATIONS

Nurses should assess parental readiness prior to the discharge of newborns by using the N-PRDS and provide discharge guidance and education to newborns' parents based on the outcomes of this scale.

Parent Experiences in the NICU and Transition to Home

Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.