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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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Xu W, Liu J, Meng X, Zhang Y, Xu Y, Zhou L, Zhang F, Wang H. Status and predictors of readiness for hospital discharge in women with caesarean section: A latent profile analysis. Midwifery 2024; 133:103994. [PMID: 38608543 DOI: 10.1016/j.midw.2024.103994] [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: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Women undergoing caesarean section (CS) experience difficulties when preparing for discharge, and readiness for hospital discharge (RHD) may depend on individual characteristics. OBJECTIVE To explore the status of RHD in women with CS, identify the latent classes of RHD, and analyse predictors from a bio-psycho-social perspective. METHODS A sample of 410 women with CS completed the following questionnaires on demographic and obstetric characteristics: Readiness for Hospital Discharge Study-New Mother Form (RHDS-NMF), Parents' Postnatal Sense of Security (PPSS), Quality of Discharge Teaching Scale (OB-QDTS), and Postpartum Support Questionnaire (PSQ). Latent profile analysis was used to identify the latent classes of RHD. Multiple logistic regression analysis was used to analyse the predictors. RESULTS In total, 96.6 % of women with CS reported discharge ready, and the score of RHDS-NMF was 136.09 ± 25.59. Three latent classes were identified as Low RHD (16.1 %), Moderate RHD (41.7 %), and High RHD (42.2 %). Primiparas (OR = 2.867 / 1.773; P = 0.012 / 0.033), emergency CS (OR = 3.134 / 2.470; P = 0.006 / 0.002), lower levels of PPSS (OR = 0.909 / 0.942; P = 0.009 / 0.013) and OB-ODTS (OR = 0.948 / 0.975; P < 0.001) were associated with Moderate and Low RHD. Lower PSQ predicted a higher probability of Low RHD (OR = 0.955; P = 0.038). CONCLUSIONS The perception of RHD by women in the study was inaccurate, with more than half not being classified as High RHD. Healthcare professionals can anticipate interventions for maternal well-being based on the characteristics of the different RHD classes.
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Affiliation(s)
- Wenli Xu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Jia Liu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Xinhai Meng
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Yuxin Zhang
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Yaxuan Xu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Lihua Zhou
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China.
| | - Fengying Zhang
- The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City 230022 Anhui Province, PR China
| | - Hui Wang
- The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City 230022 Anhui Province, PR China
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Tajalli S, Ebadi A, Parvizy S, Kenner C. Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study. BMC Nurs 2024; 23:297. [PMID: 38685021 PMCID: PMC11057165 DOI: 10.1186/s12912-024-01960-7] [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: 11/24/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking. OBJECTIVE The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants. METHOD A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity. RESULT Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively. CONCLUSION Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.
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Affiliation(s)
- Saleheh Tajalli
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Soroor Parvizy
- Nursing and Midwifery Care Research Center, Pediatric Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Carole Kenner
- School of Nursing and Health Sciences, The College of New Jersey, Ewing, NJ, USA
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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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Gao S, Huang N, Huang W, Lian Y, Xiao H, Yao S. Position Adherence in Patients Underwent Pars Plana Vitrectomy with Silicone Oil Tamponade. Patient Prefer Adherence 2024; 18:829-838. [PMID: 38645698 PMCID: PMC11027915 DOI: 10.2147/ppa.s453683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Position adherence of patients with Pars Plana Vitrectomy with Silicone Oil Tamponade after discharge is of positive significance. However, patients undergoing a day surgery makes the quality of discharge teaching and readiness for hospital discharge is insufficient, which will influence their position adherence at home. Aim This study aimed to find the correlation of discharge teaching, readiness for hospital discharge, and position adherence in patients who underwent PPV with silicone oil tamponade from the day ward. Methods This was a cross-sectional survey. One hundred ninety-four patients with day surgery were recruited by convenient sampling from Zhongshan Ophthalmic Center, China. Data were collected using the quality of discharge teaching scale, readiness for hospital discharge scale, and position adherence scale. Results Patients' education level, residence, poor postoperative vision, ophthalmic surgery history, and quality of discharge teaching are the main factors of readiness for discharge. Only 41(21%) patients had good position adherence, and education level and readiness for discharge are the main factors of position adherence. Discussion Discharge teaching improves patients' knowledge and competence of self-care and helps patients prepare for the transition from hospital to home, and readiness for hospital discharge significantly influences position adherence after discharge and indirectly plays a vital role in postoperative vision recovery and surgical effect.
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Affiliation(s)
- Saiyu Gao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Nanqi Huang
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Wenmin Huang
- Ocular Emergency and Trauma Department, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Yu Lian
- Ocular Emergency and Trauma Department, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Huiming Xiao
- Ocular Emergency and Trauma Department, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Shuyu Yao
- Ocular Emergency and Trauma Department, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
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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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Ji Y, Ma H, Jin Y, Song Y. Correlation between nursing dependence and discharge readiness in middle-aged and elderly patients undergoing coronary-artery bypass grafting. Asian J Surg 2024; 47:1038-1039. [PMID: 37945399 DOI: 10.1016/j.asjsur.2023.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- YanXia Ji
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Hong Ma
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yanan Jin
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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Zhao J, Ding W, Fan B, Chen C, Wang L. Development of the Readiness for Hospital Discharge Scale for Patients with Bile Duct Carcinoma Catheterized After Percutaneous Transhepatic Cholangial Drainage: A Validity and Reliability Study. Risk Manag Healthc Policy 2024; 17:117-126. [PMID: 38229835 PMCID: PMC10790586 DOI: 10.2147/rmhp.s445841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024] Open
Abstract
Objective We develop the Readiness for Hospital Discharge Scale (RHDS) for patients with bile duct carcinoma catheterized after percutaneous transhepatic cholangial drainage (PTCD) and test the reliability and validity of the scale, so as to provide a quantitative tool for evaluating the discharge readiness of patients catheterized after PTCD. Methods The initial scale was developed following literature review, qualitative interviews, expert consultation, and other methods based on Meleis' Theory of Transition. We selected a total of 286 patients with bile duct carcinoma catheterized after PTCD from four tertiary A-grade hospitals in Nantong City. We conducted a cross-sectional survey using the initial scale to test the validity and reliability of the scale. Results RHDS for patients catheterized post-PTCD consisted of five dimensions, with a cumulative variance contribution rate of 74.6%. The Cronbach's α coefficient of the scale was 0.856, and that of each dimension was between 0.740 and 0.891; the scale-content validity index (S-CVI) was 0.875. Conclusion RHDS for patients with bile duct carcinoma catheterized after PTCD developed in this study, has good reliability and validity, and can be a useful tool for evaluating the discharge readiness of patients with bile duct carcinoma catheterized after PTCD.
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Affiliation(s)
- Jia Zhao
- Department of Interventional Radiology, Nantong First People’s Hospital, Nantong, 226001, People’s Republic of China
| | - Wenbin Ding
- Department of Interventional Radiology, Nantong First People’s Hospital, Nantong, 226001, People’s Republic of China
| | - Benfang Fan
- Nursing Department, Nantong First People’s Hospital, Nantong, 226001, People’s Republic of China
| | - Chunxia Chen
- Department of Interventional Radiology, Nantong First People’s Hospital, Nantong, 226001, People’s Republic of China
| | - Lihua Wang
- Nursing Department, Nantong First People’s Hospital, Nantong, 226001, People’s Republic of China
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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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Talat N, Khan RA, Khan KA, Aziz MU, Tahir W, Mirza MB. Reliability and validity of Urdu PARENTS for assessing non-technical skills of paediatric residents in a teaching hospital in Pakistan. BMC MEDICAL EDUCATION 2023; 23:951. [PMID: 38087274 PMCID: PMC10717365 DOI: 10.1186/s12909-023-04938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The primary objective of our study is twofold. First, we assessed nontechnical skills (NTSs), such as the cognitive, social, and personal skills of postgraduate residents (PGRs), from paediatric caregivers' perspectives in a paediatric emergency department (PED) of a tertiary care hospital. Second, we evaluated the reliability and validity of the 'Parents' Assessment of Residents Enacting Non-Technical Skills' (PARENTS) instrument in its Urdu-translated version, ensuring its applicability and accuracy in the Pakistani context. MATERIALS AND METHODS This mixed-method study used an instrument translation and validation design. We translated an existing instrument, PARENTS, into Urdu, the national language of Pakistan, and administered it to paediatric caregivers in the PED of a tertiary care hospital. We collected data from 471 paediatric caregivers and coded them for analysis in AMOS and SPSS. RESULTS The Urdu-translated version of the PARENTS demonstrated reliability and internal validity in our study. The findings from the assessment revealed that paediatric caregivers expressed satisfaction with the knowledge and skill of residents. However, there was comparatively lower satisfaction regarding the residents' display of patience or empathy towards the children under their care. CONCLUSION The study findings support the validity and reliability of the PARENTS as an effective instrument for assessing the NTS of PGRs from the perspective of paediatric caregivers. With its demonstrated efficacy, medical educators can utilize PARENTS to pinpoint specific areas that require attention regarding the NTS of PGRs, thus facilitating targeted interventions for enhanced patient care outcomes.
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Affiliation(s)
- Nabila Talat
- Department of Paediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
| | - Rehan Ahmed Khan
- Department of Medical Education, Riphah International University, Islamabad, Pakistan
| | - Khalid Ahmad Khan
- Department of Management Sciences, Riphah International University, Lahore, Pakistan
| | - Muhammad Usama Aziz
- Department of Paediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Warda Tahir
- Department of Paediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Bilal Mirza
- Department of Paediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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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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12
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Hjorth-Johansen E, Børøsund E, Moen A, Harmens A, Martinsen I, Wik G, Fredriksen BE, Eger SHW, Holmstrøm H. Heart OBServation app: development of a decision support tool for parents of infants with severe cardiac disease. Cardiol Young 2023; 33:1350-1358. [PMID: 35938297 DOI: 10.1017/s1047951122002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Many parents of infants with CHD find it difficult to recognise symptoms of deterioration in their children. Therefore, a personalised decision support application for parents has been developed. This application aims to increase parents' awareness of their infant's normal condition, help them assess signs of deterioration, decide who and when to contact health services, and what to report. The aim of this paper is to describe the concept and report results from a usability study. METHODS An interprofessional group developed a mobile application called the Heart OBServation app in close collaboration with parents using an iterative process. We performed a usability study consisting of semi-structured interviews of 10 families at discharge and after one month and arranged two focus group interviews with nurses caring for these families. A thematic framework analysis of the interviews explored the usability of features in the application. Usability was assessed twice using the System Usability Scale, and a user log was registered throughout the study. RESULTS The overall system usability score, 82.3 after discharge and 81.7 after one month, indicates good system usability. The features of Heart OBServation were perceived as useful to provide tailored information, increase awareness of the child's normal condition, and to guide parents in what to look for. To empower parents, an interactive discharge checklist was added. CONCLUSIONS The Heart OBServation demonstrated good usability and was well received by parents and nurses. Feasibility and benefits of this application in clinical practice will be investigated in further studies.
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Affiliation(s)
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anna Harmens
- South-Eastern Norway Regional Health Authority, Oslo, Norway
| | - Ingeborg Martinsen
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Gunnar Wik
- Department of Paediatric and Adolescent Medicine, Sorlandet Hospital, Kristiansand, Norway
| | | | - Siw H W Eger
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
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13
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Lau E, Adams YJ, Ghiaseddin R, Sobiech K, Ehla EE. Discharge Readiness and Associated Factors Among Postpartum Women in Tamale, Ghana. West J Nurs Res 2023; 45:539-546. [PMID: 36782383 DOI: 10.1177/01939459231152122] [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: 02/15/2023]
Abstract
Ghana experiences a relatively high maternal mortality ratio, with the majority of maternal deaths occurring in the postpartum period. Discharge readiness is a reliable indicator of maternal health outcomes and involves a postpartum woman's perception of preparedness to leave the hospital following delivery. We measured the discharge readiness of postpartum women in Ghana through an institutional-based cross-sectional study involving 151 participants. Participants completed an interviewer-administered survey, and data analyses included linear regression models. The study sample demonstrated relatively high discharge readiness, with a mean score of 177.57 on a scale from 0.00 to 220.00. Higher gravidity was positively associated with discharge readiness score, while longer length of hospital stay and receiving educational handouts were negatively associated with discharge readiness score. Clinical interventions addressing the factors found to be associated with discharge readiness have significant potential to improve postpartum care and maternal outcomes in Ghana.
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Affiliation(s)
- Elizabeth Lau
- College of Science, University of Notre Dame, Notre Dame, IN, USA
| | | | - Roya Ghiaseddin
- Department of Applied and Computational Mathematics & Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Kathleen Sobiech
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
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14
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Teixeira MJC, Khouri M, Martinez E, Bench S. Implementing a discharge process for patients undergoing elective surgery: Rapid review. Int J Orthop Trauma Nurs 2023; 48:101001. [PMID: 36805314 DOI: 10.1016/j.ijotn.2023.101001] [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: 10/01/2022] [Revised: 01/14/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hospital discharge is a 'vulnerable stage' in care. A delayed, inappropriate or poorly planned discharge increases hazards and costs, inhibiting recovery, and often leading to unplanned readmission. New discharge processes could boost practice, reduce the length of stay, and, consequently, reduce costs and improve patients' quality of life. AIM To identify technology based interventions that have been implemented to facilitate a safe and timely discharge procedure after elective surgery, and to describe implementation barriers and facilitators and patient satisfaction. METHOD This rapid review followed a restricted systematic review framework, searching Medline, EMBASE, CINAHL, PsychINFO, and ClinicalTrials.gov. for relevant studies published from 2015 to 2021 in English. RESULTS Eleven studies were included. Most interventions were machine-learning-based, and only one study reported patient involvement. Effective leadership, team work and communication were stated as implementation facilitators. The main barriers to implementation were: lack of support from leaders, poor clinical documentation, resistance to change, and financial and logistical concerns. None of the studies evaluated patient satisfaction. CONCLUSIONS Findings highlight factors that support the implementation of technology based interventions aimed at a safe and timely discharge process following elective surgery. Nurses play an important role in the provision of information, and in the development and implementation of discharge processes.
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Affiliation(s)
- Maria J C Teixeira
- Nursing Research Department, Royal National Orthopaedic Hospital NHS Trust, London, UK; London South Bank University, London, UK; Nuffield Health, The Manor Hospital, Oxford, UK.
| | - Ma'ali Khouri
- Institute of Orthopaedics Library, University College London, London, UK
| | - Evangeline Martinez
- Functional and Restorative Services, London Spinal Cord Injury Research Centre, Royal National Orthopaedic Hospital NHS Trust, London, UK; University College London, London, UK
| | - Suzanne Bench
- London South Bank University, London, UK; ACORN A Centre of Research for Nurses & Midwives, Guys and St Thomas's NHS Trust, Lond, UK
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15
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Hjorth-Johansen E, Børøsund E, Martinsen Østen I, Holmstrøm H, Moen A. Acceptability and Initial Adoption of the Heart Observation App for Infants with Congenital Heart Disease: A Qualitative Study (Preprint). JMIR Form Res 2023; 7:e45920. [PMID: 37018028 PMCID: PMC10131881 DOI: 10.2196/45920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. OBJECTIVE This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents' understanding and management of their child's condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. METHODS A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant's primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. RESULTS The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents' receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an "everyday app" and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals' attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant's condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). CONCLUSIONS This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents' receptivity. By doing so, parents may be confident to know what to look for regarding their child's health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system.
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Affiliation(s)
- Elin Hjorth-Johansen
- Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ingeborg Martinsen Østen
- Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Cardiology, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Moen
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Kolarczyk E, Witkowska A, Szymiczek M, Młynarska A. The Variables of the Readiness for Discharge from Hospital in Patients after Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1582. [PMID: 36674337 PMCID: PMC9867362 DOI: 10.3390/ijerph20021582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
Discharge after myocardial infarction (MI) reduces the risk of repeated myocardial infarction and stroke and has a positive effect on the patient’s prognosis. An important element of preparation is the assessment of the patient’s readiness for discharge from hospital. This study aimed to evaluate the associations between a patient’s readiness for hospital discharge after MI, their functioning in the chronic illness, and socio-demographic and clinical variables. Methods: This was a cross-sectional, single-center study. The study was conducted among 242 patients who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and the Functioning in Chronic Illness Scale (FCIS) were used. Results: No statistically significant differences were found between socio-demographic and clinical factors and the overall result of the RHD-MIS (p >0.05).There is a positive correlation between hospital discharge readiness and functioning in chronic disease in patients after MI (r = 0.20; p < 0.001). The higher the level of subjective knowledge, the better the functioning in chronic disease (rho = 0.16; p < 0.05), the greater the increase in the sense of influence on the course of the disease (rho = 0.17; p < 0.05) and the greater the decrease in the impact of the disease on the patient’s attitude (rho = 0.23, p < 0.05). Conclusions: The higher the readiness for discharge from hospital, the better the patient’s functioning in the disease and the lower the impact of the disease on the patient.
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Affiliation(s)
- Ewelina Kolarczyk
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Agnieszka Witkowska
- Department of Cardiology, Electrotherapy and Angiology, Scanmed S.A. Racibórz Medical Center, 47-400 Racibórz, Poland
| | - Marek Szymiczek
- Department of Cardiology, Electrotherapy and Angiology, Scanmed S.A. Racibórz Medical Center, 47-400 Racibórz, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
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17
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Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards. Soc Sci Med 2022; 312:115388. [DOI: 10.1016/j.socscimed.2022.115388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022]
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Goto Y, Miura H, Ito N. Comparison between the Chief Care Manager and the Normal Care Manager on Hospitalization and Discharge Coordination Activities in Japan: An Online Cross-Sectional Study of Care Managers in Aichi Prefecture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12122. [PMID: 36231421 PMCID: PMC9565180 DOI: 10.3390/ijerph191912122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
The Japanese long-term care insurance system came into operation in the year 2000 and the chief care manager certification system was established in 2006 to improve the quality of care management. Certified chief care managers are expected to perform the role of a specialist. The purpose of this study was to determine the impact of the chief care manager certificate in coordination with hospitals. In this online cross-sectional survey, responses were obtained from 448 care managers engaged in long-term care activities with all in-home long-term care support providers. Among these 448 care managers, 301 had the chief care manager certificate. Of these care managers, ≥90% regularly asked their patients about their "values" and ≥80% provided their patients with hospitalization and discharge support. Of the care managers who provided their patients with hospitalization support, 80% provided the hospitals with information regarding patient "values" at the time of hospitalization, and 50% provided the hospitals with information regarding patient "values" and information. The chief care manager certificate had positive effects on confidence in hospitalization and discharge support. However, no significant difference was observed between the activities of chief and normal care managers in terms of hospitalization and discharge support.
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Affiliation(s)
- Yuko Goto
- Correspondence: ; Tel.: +81-562-46-2311
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19
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Framework for successful school reintegration after psychiatric hospitalization: A systematic synthesis of expert recommendations. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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King L, Harrington A, Nicholls S, Thornton K, Tanner E. Towards reduction of preventable hospital readmission: Older people and family members' views on planned self-management of care at home. J Clin Nurs 2022. [PMID: 35974684 DOI: 10.1111/jocn.16492] [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: 02/18/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To reduce the likelihood of preventable readmissions, the aim was to investigate how older people (with their family members) managed their chronic health conditions at home following hospital discharge. The objectives explored older people and their family members' perspectives on how discharge plans assisted self-management of their chronic conditions, their recognition of deterioration and when to seek treatment/re-attend hospital. BACKGROUND Chronic conditions have challenged older adults' self-management, particularly after hospital discharge and can impact on preventable readmission. Few studies have examined patients' and their family members' perspectives on the management of their conditions at home after hospitalisation. DESIGN A qualitative exploratory design known as Interpretive Description was utilised. METHODS Purposeful sampling involved 27 community-dwelling older adults; nineteen were discharged patients with one or more chronic health conditions. Eight nominated family members were also recruited to enhance understanding of the older persons' self-management at home. Interviews were undertaken and thematic data analysis followed the COREQ guidelines. RESULTS Five themes emerged: (1) Post-Discharge Advice; (2) Managing at Home; (3) Recognition and Response to Deterioration; (4) Community Care and Support; and (5) The "Burden" on Others of Post-Discharge Care. CONCLUSION Older people sought a clear plan for self-management at home prior to discharge. This plan should contain potential signs of deterioration and guidance on future action. We found that support given to older people from family and friends was critical to prevent readmission. In addition, their local General Practitioner and Pharmacist played an essential part in the support of their care. For some, social support services were also important. Nurse telephone follow-up in the week following discharge was mostly absent. However, this strategy would be strongly recommended. RELEVANCE TO CLINICAL PRACTICE To mitigate against preventable readmission, we recommend the above strategies to assist the older person at home with self-management of their chronic conditions.
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Affiliation(s)
- Lindy King
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Adjunct Research Professor, Australian Centre for Christianity and Culture, Charles Sturt University, Barton, Australian Capital Territory, Australia
| | - Seth Nicholls
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karleen Thornton
- Nursing and Midwifery Education, Research and Practice Development, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Elizabeth Tanner
- Gerontology and Interprofessional Education and Practice, School of Nursing and School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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21
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Huang RY, Lee TT, Lin YH, Liu CY, Wu HC, Huang SH. Factors Related to Family Caregivers’ Readiness for the Hospital Discharge of Advanced Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138097. [PMID: 35805756 PMCID: PMC9266053 DOI: 10.3390/ijerph19138097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023]
Abstract
Background: Many family caregivers of advanced cancer patients worry about being unable to provide in-home care and delay the discharge. Little is known about the influencing factors of discharge readiness. Methods: This study aimed to investigate the influencing factors of family caregivers’ readiness, used a cross-sectional survey, and enrolled 123 sets of advanced cancer patients and family caregivers using convenience sampling from four oncology wards in a medical centre in northern Taiwan. A self-developed five-point Likert questionnaire, the “Discharge Care Assessment Scale”, surveyed the family caregivers’ difficulties with providing in-home care. Results: The study showed that the discharge readiness of family caregivers affects whether patients can be discharged home. Moreover, the influencing factors of family caregivers’ discharge readiness were the patient’s physical activity performance status and expressed discharge willingness; the presence of someone to assist family caregivers with in-home care; and the difficulties of in-home care. The best prediction model accuracy was78.0%, and the Nagelkerke R2 was 0.52. Conclusion: Discharge planning should start at the point of admission data collection, with the influencing factors of family caregivers’ discharge readiness. It is essential to help patients increase the likelihood of being discharged home.
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Affiliation(s)
- Ru-Yu Huang
- Department of Nursing, Mackay Memorial Hospital Tamsui Branch, New Taipei City 25160, Taiwan; (R.-Y.H.); (H.-C.W.)
| | - Ting-Ting Lee
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Yi-Hsien Lin
- Division of Radiotherapy, Cheng Hsin General Hospital, Taipei 11220, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Hsiu-Chun Wu
- Department of Nursing, Mackay Memorial Hospital Tamsui Branch, New Taipei City 25160, Taiwan; (R.-Y.H.); (H.-C.W.)
| | - Shu-He Huang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Correspondence: ; Tel.: +886-2-2826-7227; Fax: +886-2-2822-9973
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22
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Grieco M, Galiffa G, Lorenzon L, Marincola G, Persiani R, Santoro R, Pernazza G, Brescia A, Santoro E, Stipa F, Crucitti A, Mancini S, Palmieri RM, Di Paola M, Sacchi M, Carlini M. Enhanced recovery after surgery (ERAS) program in octogenarian patients: a propensity score matching analysis on the "Lazio Network" database. Langenbecks Arch Surg 2022; 407:3079-3088. [PMID: 35697818 DOI: 10.1007/s00423-022-02580-y] [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: 11/18/2021] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the safety and compliance with the enhanced recovery after surgery (ERAS) protocol in octogenarian patients undergoing colorectal surgery in 12 Italian high-volume centers. METHODS A retrospective analysis was conducted in a consecutive series of patients who underwent elective colorectal surgery between 2016 and 2018. Patients were grouped by age (≥ 80 years vs < 80 years), propensity score matching (PSM) analysis was performed, and the groups were compared regarding clinical outcomes and the mean number of ERAS items applied. RESULTS Out of 1646 patients identified, 310 were octogenarians. PSM identified 2 cohorts of 125 patients for the comparison of postoperative outcomes and ERAS compliance. The 2 groups were homogeneous regarding the clinical variables and mean number of ERAS items applied (11.3 vs 11.9, p-ns); however, the application of intraoperative items was greater in nonelderly patients (p 0.004). The functional recovery was similar between the two groups, as were the rates of postoperative severe complications and 30-day mortality rate. Elderly patients had more overall complications. Furthermore, the mean hospital stay was higher in the elderly group (p 0.027). Multivariable analyses documented that postoperative stay was inversely correlated with the number of ERAS items applied (p < 0.0001), whereas age ≥ 80 years significantly correlated with the overall complication rate (p 0.0419). CONCLUSION The ERAS protocol is safe in octogenarian patients, with similar levels of compliance and surgical outcomes. However, octogenarian patients have a higher rate of overall complications and a longer hospital stay than do younger patients.
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Affiliation(s)
| | | | - Laura Lorenzon
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | | | - Antonio Brescia
- Sant'Andrea University Hospital. "La Sapienza" University, Rome, Italy
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Huang L, Peng S. Status Quo and Influencing Factors of Discharge Readiness of Patients with Bilateral Ureteral Stoma After Radical Cystectomy. Front Surg 2022; 9:860162. [PMID: 36034344 PMCID: PMC9407034 DOI: 10.3389/fsurg.2022.860162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Bladder cancer is a common malignancy of the urinary system, which occurs mostly in elderly men, and the incidence is increasing year by year. To analyze the status quo and related factors of discharge readiness of patients with bilateral ureteral stoma after radical cystectomy, a retrospective, noncomparative was performed. 544 patients with bilateral ureteral stoma after radical cystectomy in our hospital from December 2018 to December 2020 were selected. The self-designed questionnaire, discharge readiness scale (RHDS) and discharge guidance quality scale (QDTS) were used to investigate the general data, and multiple linear regression was used to analyze the related influencing factors. The total score of RHDS was (72.57 ± 18.56) and the total score of QDTS was (105.63 ± 24.18); the total score of RHDS was positively correlated with the total score of QDTS (r = 0.882, p = 0.000); the results of multiple linear regression showed that age, discharge direction and care mode were the main factors influencing the discharge readiness of patients (p < 0.05). In conclusions, the discharge readiness of patients with bilateral ureteral stoma after radical cystectomy is in the medium level, and there is a large space for improvement. Nurses should strengthen the guidance and nursing of patients’ discharge preparation to reduce the incidence of postoperative complications and readmission rate.
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Mehraeen P, Jafaraghaee F, Paryad E, Kazemnejad Leyli E. Comparison of Nurses' and Patients' Readiness for Hospital Discharge: A Multicenter Study. J Patient Exp 2022; 9:23743735221092552. [PMID: 35465410 PMCID: PMC9021514 DOI: 10.1177/23743735221092552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Decision to discharge is often based solely on clinical criteria but readiness for discharge is multifactorial and perceived differently by patients, families, nurses, and physicians. This is an analytical cross-sectional study aimed to compare perceptions of readiness to discharge 452 patients and their assigned nurses on the day of hospital discharge. To compare perceptions of readiness to discharge patients and their assigned nurses on the day of hospital discharge via readiness for hospital discharge (RHD) self-reported questionnaire. The biggest difference between nurses and patients’ perception scores was in the knowledge subscale. The results of linear regression model showed that patients’ gender, education, occupation, ward, nurse’s age, and marital status predict the difference between nurses and patients’ perception of readiness. Hospitalization in ear, nose, and throat (ENT) department with increasing difference and the older age of nurses is associated with a decrease in the difference between the perception. Assessment of nurse’s self-readiness can help with the development of care and education planning tailored to patients’ needs before discharge.
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Affiliation(s)
- Parisa Mehraeen
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Jafaraghaee
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Ezzat Paryad
- Instructor of Medical Surgical Nursing, College of Nursing and Midwifery, Guilan University of medical sciences, Rasht, Iran
| | - Ehsan Kazemnejad Leyli
- Department of Biostatistics, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Cai W, Zheng X, Wang R, Zhu H, Xu X, Shen X, Zhang C. Factors of Parents-Reported Readiness for Hospital Discharge in Children with Acute Leukemia: A Cross-Sectional Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4082196. [PMID: 35494518 PMCID: PMC9054479 DOI: 10.1155/2022/4082196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/26/2022] [Accepted: 04/01/2022] [Indexed: 12/04/2022]
Abstract
Aim The aim of this study is to investigate the existing status and to explore the influencing factors of parents-reported readiness for hospital discharge in children with acute leukemia (AL) in China and to propose optimizing pathways and recommendations of discharge readiness for clinical reference. Methods A cross-sectional survey was conducted for the 122 children with AL who were discharged from the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University; their parents were investigated by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). Data were collected between September 2020 and May 2021.Univariate analysis and multivariate logistic regression analysis were performed to explore the influencing factors of readiness for hospital discharge. Results The 122 children with AL included 52 females and 70 males with mean age 6.08 years. The total RHDS score was 7.7 ± 1.2, and 68.9% of the participants had high readiness for hospital discharge (RHDS score >7). The total QDTS score was 7.6 ± 2.0. Parent marital status (OR = 4.86, 95% CI: 1.31-18.05), education status (OR = 3.86, 95% CI: 1.18-12.55), family per capita monthly income (OR = 1.08, 95% CI: 1.01-2.99), and high QDTS (OR = 1.56, 95% CI: 1.11-2.68) were risk factors for high RHDS. Conclusions Our data suggest parents of children with AL had high readiness for hospital discharge and had the ability to take care of their children after discharge. Parental marital status, education status, QDTS score, and family per capita monthly income were independently associated with high RHDS.
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Affiliation(s)
- Wei Cai
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiaofen Zheng
- Department of Pediatric Nephrology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Runping Wang
- Department of Children's Hematology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Huifen Zhu
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xinxin Xu
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiaowen Shen
- Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Chunmei Zhang
- Department of Nursing, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- Nursing School, Wenzhou Medical University, Wenzhou, China
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Posri N, Srisatidnarakul B, Hickman RL. Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. BELITUNG NURSING JOURNAL 2022; 8:75-83. [PMID: 37521078 PMCID: PMC10386804 DOI: 10.33546/bnj.1968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/12/2021] [Accepted: 01/08/2022] [Indexed: 08/01/2023] Open
Abstract
Background The transition from hospital to home among patients with stroke is quite challenging. If the patients are not ready for hospital discharge, their condition may worsen, which also causes a high rate of readmission. Although instruments to measure readiness for hospital discharge exist, none of them fit with the Thailand context. Objective This study aimed to develop a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. Methods The study was conducted from February to September 2020, which consisted of several steps: 1) conducting an extensive literature review, 2) content validity with five experts, 3) pilot testing with 30 samples, and 4) field testing with 348 participants. Content validity index (CVI) was used to measure the content validity, Cronbach's alpha and inter-item correlation to evaluate reliability, and multiple logistic regression analysis to measure the construct validity. Results The findings showed good validity and reliability, with I-CVI of 0.85, Cronbach's alpha of 0.94, and corrected item-total correlation ranging from 0.43 to 0.86. The construct validity was demonstrated through the results of regression analysis showing that the nine variables include level of consciousness (OR = 0.544; CI 95% = 0.311 - 0.951), verbal response (OR = 0.445; 95% CI 0.272- 0.729), motor power right leg (OR = 0.165; 95% CI 0.56- 0.485), visual field (OR = 0.188; 95% CI 0.60-0.587), dysphagia (OR = 0.618; 95% CI 0.410-0.932), mobility (OR = 0.376; 95% CI 0.190 - 0.741), self-feeding (OR = 0.098; 95% CI 0.036 -0.265), bathing (OR = 0.099; 95% CI 0.026-0.378), and bladder control (OR = 0.589; 95% CI 0.355-0.977) that significantly influenced the hospital readmission within 30 days in patients with stroke. Conclusion The Readiness for Hospital Discharge assessment tool is valid and reliable. Healthcare providers, especially nurses, can use this tool to assess discharge conditions for patients with stroke with greater accuracy in predicting hospital readmission.
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Affiliation(s)
| | | | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Schultz BE, Corbett CF, Hughes RG. Instrumental support: A conceptual analysis. Nurs Forum 2022; 57:665-670. [PMID: 35133664 PMCID: PMC9544712 DOI: 10.1111/nuf.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/27/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
The aim of this paper was to use the Walker and Avant method of concept analysis to evaluate the concept of instrumental support in the context of hospital to home care transitions. Findings from this concept analysis suggest three defining attributes of instrumental support: informal support providers, tangible support, and unmet personal needs. Antecedents identified: a strong and supportive social network, an independently functioning adult, an illness resulting in hospitalization, a change in functional status, and the patient being discharged home from the hospital. Consequences of not having adequate instrumental support: unsuccessful recovery at home, increased risk for hospital readmission, decline in physical functioning, health complications, and increased risk of mortality. Empirical referents: patient's report of successful recovery, returning to an independent level of functioning, and the lack of hospital readmission or health complication. A model and a contrary case study were developed to provide examples of clinical cases related to instrumental support. Recommendations related to clinical practice include evaluating the availability/adequacy of instrumental support before hospital discharge and including the identified instrumental support person in the discharge planning process. There are proven benefits of having people within one's social network providing instrumental support during the home recovery period.
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Affiliation(s)
- Beth E. Schultz
- College of Pharmacy, Natural & Health Sciences Manchester University Fort Wayne Indiana USA
| | - Cynthia F. Corbett
- College of Nursing University of South Carolina Columbia South Carolina USA
| | - Ronda G. Hughes
- College of Nursing University of South Carolina Columbia South Carolina USA
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Yoshimura M, Sumi N. Measurement tools that assess the quality of transitional care from patients' perspective: A literature review. Jpn J Nurs Sci 2022; 19:e12472. [PMID: 35132783 DOI: 10.1111/jjns.12472] [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: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
AIM Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. METHODS Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." CONCLUSION The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Schultz BE, Corbett CF, Hughes RG, Bell N. Scoping review: Social support impacts hospital readmission rates. J Clin Nurs 2021; 31:2691-2705. [PMID: 34866259 DOI: 10.1111/jocn.16143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To review and synthesise the current literature on social support and hospital readmission rates. BACKGROUND Hospital readmission rates have not declined significantly since 2010 despite efforts to identify and implement strategies to reduce readmissions. After discharge, patients often report the need for help at home with personal care, medical care and/or transportation. Social factors can positively or negatively affect the transition from hospital to home and the extended recovery period experienced by patients. METHODS Published primary studies in peer-reviewed journals, written in English, assessing the adult medical/surgical population and discussing social support and hospital readmission rates were included. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was completed for this scoping review. RESULTS The search resulted in 2919 articles. After removing duplicates and reviewing content for the inclusion and exclusion criteria, 23 articles were selected for review. Social support is provided by those within one's social circle. There are several types of social support and depending on the needs to the patient, the type of social required and provided is different. CONCLUSIONS The most common form of social support needed at home for people recovering after a hospitalisation was instrumental support, tangible care in the form of assistance with daily personal and medical care, and transportation. Patients who lacked adequate social support after discharge were at an increased risk of hospital readmission. RELEVANCE TO CLINICAL PRACTICE Identifying factors, such as social support, that may impact hospital readmission rates is important for quality hospital to home care transitions. Assessing patients' needs and available social support to meet those needs may be an essential part of the discharge planning process to decrease the risk of hospital readmission.
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Affiliation(s)
- Beth E Schultz
- University of South Carolina, Columbia, South Columbia, USA
| | | | - Ronda G Hughes
- University of South Carolina, Columbia, South Columbia, USA
| | - Nathaniel Bell
- University of South Carolina, Columbia, South Columbia, USA
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Kim JH, Shin YS. Discharge Transition Experience for Lumbar Fusion Patients: A Qualitative Study. J Neurosci Nurs 2021; 53:228-232. [PMID: 34620802 PMCID: PMC8575165 DOI: 10.1097/jnn.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Support should be provided to individuals who are ready to be discharged; however, quantitative research is lacking in understanding the challenges of postsurgery lumbar fusion patients' discharge and transition. This article delves into the in-depth experience of lumbar fusion patients with discharge transitions. METHODS: We conducted semistructured individual interviews with 11 patients who had lumbar fusion surgery at one of Korea's most equipped general hospitals. These interviews focused on the patients' discharge transition experiences. The data were analyzed using phenomenological analysis. RESULTS: Lumbar fusion patients' experiences of discharge transition fit into 4 categories: anticipation of surgical transition, the process of transition to discharge, the difficult process of recovery, and recovery strategy. CONCLUSION: To further expedite the discharge process and make better use of cooperative hospital resources, conducting preoperative treatment planning, identifying family and social support systems, and sharing treatment procedures are all required. Furthermore, thorough health information services and step-by-step courses on predicted problems and everyday living after surgery should be considered for postoperative education. It is critical to broadening the scope of preoperative and postoperative education programs, as well as assistance for the social support system, such as the family-based support system and cooperative hospitals.
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Dammann M, Staudacher S, Simon M, Jeitziner MM. Insights into the challenges faced by chronically critically ill patients, their families and healthcare providers: An interpretive description. Intensive Crit Care Nurs 2021; 68:103135. [PMID: 34736830 DOI: 10.1016/j.iccn.2021.103135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/03/2021] [Accepted: 08/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe and understand the challenges of patients with chronic critical illness (CCI), their families and healthcare providers during the disease trajectory. METHODOLOGY/DESIGN This qualitative study follows Thorne's methodology of interpretive description and was guided by the ethnographic method of observation and participation. Five cases, each comprising one patient with chronic critical illness their family members and several healthcare providers, were followed from the intensive care unit of a university hospital in Switzerland across different settings. In total, five patients with chronic critical illness, 12 family members and 92 healthcare providers (nurses, nursing students, care assistants, physiotherapists and occupational therapists and physicians) were observed. FINDINGS Regardless of the medical diagnoses and disease trajectories of the patients with chronic critical illness, all cases faced three main challenges: 1. Dealing with the unpredictability of the disease trajectory beyond the underlying disease. 2. Coping with the complexity of care. 3. Perceiving communication challenges despite all involved parties' dependency on it. CONCLUSION Unpredictability is not only a unique characteristic of the prolonged disease trajectory of patients with chronic critical illness, but also one of the main challenges of the participants. Therefore, the way unpredictability is handled is dependent on changes in the complexity of care and communication, highlighting the need for participation, information, empathy, clarity and honesty among all participants.
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Affiliation(s)
- Maria Dammann
- Department of Nephrology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Sandra Staudacher
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Nursing Research Unit, Department of Nursing, University Hospital Bern (Inselspital), Freiburgstrasse 4, 3010 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.
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Lilleheie I, Debesay J, Bye A, Bergland A. The tension between carrying a burden and feeling like a burden: a qualitative study of informal caregivers' and care recipients' experiences after patient discharge from hospital. Int J Qual Stud Health Well-being 2021; 16:1855751. [PMID: 33345749 PMCID: PMC7758041 DOI: 10.1080/17482631.2020.1855751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose: The number of people aged 80 and above is projected to triple over the next 30 years. Expanding public expenditure on long-term care servicesHas made policies encouraged informal caregiving. Burden of care describes challenges connected to informal caregiving. Dependent patients report feelings of being a burden. Few studies have focused on both the experience of caregiver burden and recipients' feelings of burden. This study explore the experiences of old patients and informal caregivers in the first 30 days after the patient's discharge. Method: Aphenomenological approach was used to explore the subjective experiences of the participants . Semi-structured individual interviews were analysed thematically. Results: The reults reflect imbalance regarding care needs relative to time, social roles, physical and emotional states, and formal care resources. Four themes emerged from the interviews: 1) Bridging the gap, 2) Family is family, 3) Never enough, and 4) Stress and distress. Conclusions: The participants face strains within their roles. The care situation has potential to be burdensome. To secure healthcare quality for old patients, the informal carer's role needs to be recognized. Informal care based on altruism and reciprocity seems to be positive, whereas informal care based on family norms might have a negative impact.
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Affiliation(s)
- Ingvild Lilleheie
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway, and European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway
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Zhang X, Tang C, Xiao X, Sun M, Wang H. Readiness for Hospital Discharge and Its Correlates Among People Living With HIV in Hunan, China: A Cross-sectional Study. J Assoc Nurses AIDS Care 2021; 32:619-628. [PMID: 34115720 DOI: 10.1097/jnc.0000000000000278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We aimed to (a) describe the readiness for hospital discharge in people living with HIV and (b) explore factors associated with readiness for hospital discharge. A cross-sectional survey was conducted at two infectious disease hospitals in Hunan, China, from May to November 2017. The readiness for hospital discharge scale (RHDS) was used to assess discharge readiness. The average item mean for the RHDS ranges from 0 to 10, and higher scores represent a higher level of readiness for hospital discharge. The mean score of the RHDS was 7.78 (95% confidence interval 7.586-7.968), and 27.6% of participants (n = 56/203) felt unready for discharge (RHDS <7). We found that older age, lack of medical insurance, lower self-rated health status, poorer quality of discharge teaching, and more severe depressive symptoms were significantly associated with a lower level of readiness for hospital discharge. Interventions are needed to improve readiness of people living with HIV for hospital discharge in Hunan, China, especially for those of advanced age, without medical insurance, with worse self-rated health status, and those with higher levels of depressive symptoms.
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Affiliation(s)
- Xiaoxia Zhang
- Xiaoxia Zhang, RN, MSN, is an Assistant Professor, Department of Nursing, Henan Medical College, Henan, China; and a Graduate Student, Xiangya Nursing School of Central South University, Hunan, China
- Chulei Tang, RN, BSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Xueling Xiao, RN, MSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Manman Sun, RD, MSM, is an Assistant Professor, Department of Preclinical Medicine, Henan Medical College, Henan, China
- Honghong Wang, RN, PhD, is a Professor, Xiangya Nursing School of Central South University, Hunan, China
| | - Chulei Tang
- Xiaoxia Zhang, RN, MSN, is an Assistant Professor, Department of Nursing, Henan Medical College, Henan, China; and a Graduate Student, Xiangya Nursing School of Central South University, Hunan, China
- Chulei Tang, RN, BSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Xueling Xiao, RN, MSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Manman Sun, RD, MSM, is an Assistant Professor, Department of Preclinical Medicine, Henan Medical College, Henan, China
- Honghong Wang, RN, PhD, is a Professor, Xiangya Nursing School of Central South University, Hunan, China
| | - Xueling Xiao
- Xiaoxia Zhang, RN, MSN, is an Assistant Professor, Department of Nursing, Henan Medical College, Henan, China; and a Graduate Student, Xiangya Nursing School of Central South University, Hunan, China
- Chulei Tang, RN, BSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Xueling Xiao, RN, MSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Manman Sun, RD, MSM, is an Assistant Professor, Department of Preclinical Medicine, Henan Medical College, Henan, China
- Honghong Wang, RN, PhD, is a Professor, Xiangya Nursing School of Central South University, Hunan, China
| | - Manman Sun
- Xiaoxia Zhang, RN, MSN, is an Assistant Professor, Department of Nursing, Henan Medical College, Henan, China; and a Graduate Student, Xiangya Nursing School of Central South University, Hunan, China
- Chulei Tang, RN, BSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Xueling Xiao, RN, MSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Manman Sun, RD, MSM, is an Assistant Professor, Department of Preclinical Medicine, Henan Medical College, Henan, China
- Honghong Wang, RN, PhD, is a Professor, Xiangya Nursing School of Central South University, Hunan, China
| | - Honghong Wang
- Xiaoxia Zhang, RN, MSN, is an Assistant Professor, Department of Nursing, Henan Medical College, Henan, China; and a Graduate Student, Xiangya Nursing School of Central South University, Hunan, China
- Chulei Tang, RN, BSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Xueling Xiao, RN, MSN, is a PhD Student, Xiangya Nursing School of Central South University, Hunan, China
- Manman Sun, RD, MSM, is an Assistant Professor, Department of Preclinical Medicine, Henan Medical College, Henan, China
- Honghong Wang, RN, PhD, is a Professor, Xiangya Nursing School of Central South University, Hunan, China
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Saunders S, Weiss ME, Meaney C, Killackey T, Varenbut J, Lovrics E, Ernecoff N, Hsu AT, Stern M, Mahtani R, Wentlandt K, Isenberg SR. Examining the course of transitions from hospital to home-based palliative care: A mixed methods study. Palliat Med 2021; 35:1590-1601. [PMID: 34472398 DOI: 10.1177/02692163211023682] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care. AIM Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions. DESIGN Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3-4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data. SETTING AND PARTICIPANTS Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients (n = 25) and their caregivers (n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care. RESULTS Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress. CONCLUSIONS We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.
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Affiliation(s)
- Stephanie Saunders
- Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Chris Meaney
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jaymie Varenbut
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Natalie Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Ramona Mahtani
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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Smith VC. Discharge planning considerations for the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2021; 106:442-445. [PMID: 33046524 DOI: 10.1136/archdischild-2019-318021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/21/2020] [Indexed: 11/04/2022]
Abstract
Neonatal intensive care unit (NICU) discharge readiness is the primary caregivers' masterful attainment of technical care skills and knowledge, emotional comfort and confidence with infant care by the time of discharge. NICU discharge preparation is the process of facilitating discharge readiness. Discharge preparation is the process with discharge readiness as the goal. Our previous work described the importance of NICU discharge readiness and strategies for discharge preparation from an American medical system perspective. NICU discharge planning is, however, of international relevance as challenges in relation to hospital discharge are a recurring global theme. In this manuscript, we conceptualise NICU discharge preparation with international perspective.
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Affiliation(s)
- Vincent C Smith
- Pediatrics Division of Newborn Medicine, Boston Medical Center, Boston, Massachusetts, USA
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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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Manges KA, Wallace AS, Groves PS, Schapira MM, Burke RE. Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge. J Hosp Med 2021; 16:326-332. [PMID: 33357321 PMCID: PMC8025658 DOI: 10.12788/jhm.3464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. OBJECTIVE Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. DESIGN We surveyed interprofessional discharging teams and each team's patient at time of hospital discharge using validated tools to capture their SMMs. PARTICIPANTS Discharge events (N = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). MEASURES Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians' scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. RESULTS Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). However, team-patient SMM convergence was low: Teams overestimated the patient's self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor's level-trained nurses (P < .001) had more convergent SMMs with the patient. CONCLUSION Measuring discharge teams' SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions.
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Affiliation(s)
- Kirstin A Manges
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea S Wallace
- Division of Health Systems and Community Based Care, College of Nursing, University of Utah, Salt Lake City, Utah
| | | | - Marilyn M Schapira
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert E Burke
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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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Coatsworth-Puspoky R, Duggleby W, Dahlke S, Hunter K. Unplanned readmission for older persons: A concept analysis. J Adv Nurs 2021; 77:4291-4305. [PMID: 34028852 DOI: 10.1111/jan.14893] [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: 02/18/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this concept analysis is to define and analyse the concept of unplanned readmission to hospital for older persons. DESIGN Review the literature and analyse the concept of unplanned readmission. METHOD Guided by Walker and Avant's eight-stage method of concept analysis, four databases (Ovid MEDLINE, Scopus, CINAHL, and Embase) were searched between 1946 and 2020 for empirical studies focused on older persons with multiple chronic conditions, experiences or perspectives and unplanned readmission. A total of 34 articles (10 quantitative, 17 qualitative, three mixed methods), one concept analysis and three historical articles were included. RESULTS An unplanned readmission is an experience, process and event. The proposed definition of unplanned readmission is an older person's need for acute care treatment for an urgent or emergent health crisis that has occurred after a previous hospitalization(s). Unplanned readmission is characterized by the attributes of older persons' previous hospitalization(s), the urgent or emergent nature of the older persons' health and the older persons' need for acute care hospital services to resolve their health crisis. CONCLUSION Unplanned readmission is a complex concept that is different from planned and emergency visits/admissions and readiness for discharge. These findings provide a link for understanding unplanned readmission as a consequence of discharge readiness. Analysing this concept supports the need for older persons to seek unplanned readmission for acute care treatment of urgent and emergent health crisis, reduces the blame that older persons may feel from questions related to preventability, and stresses the need to include older persons' experiences in the development and expansion of nursing theory, interventions and current understandings of unplanned readmission.
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Affiliation(s)
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Optimizing Critical Illness Recovery: Perspectives and Solutions From the Caregivers of ICU Survivors. Crit Care Explor 2021; 3:e0420. [PMID: 34079948 PMCID: PMC8162533 DOI: 10.1097/cce.0000000000000420] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective. Design: International, qualitative study. Subjects: We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program. Setting: Seven hospitals in the United States, United Kingdom, and Australia. Interventions: None. Measurements and Main Results: Content analysis was used to explore prevalent themes related to unmet needs, as well as perceived strategies to improve ICU outcomes. Post-ICU care was perceived to be generally inadequate. Desired caregiver support fell into two main categories: practical support and emotional support. Successful care delivery initiatives included structured programs, such as post discharge telephone calls, home health programs, post-ICU clinics, and peer support groups, and standing information resources, such as written educational materials and online resources. Conclusions: This qualitative, multicenter, international study of caregivers of critical illness survivors identified consistently unmet needs, means by which caregivers accessed support post ICU, and several care mechanisms identified by caregivers as supporting optimal ICU recovery.
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Tyler N, Wright N, Panagioti M, Grundy A, Waring J. What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open-ended questionnaire study. Health Expect 2021; 24 Suppl 1:185-194. [PMID: 33471958 PMCID: PMC8137494 DOI: 10.1111/hex.13190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Historically, safety mental health research has tended to focus on risks of homicide, suicide and deaths. Although wider safety issues are now recognized in regards to mental health services, the safety of mental health transitions, a key research and policy priority according to World Health Organisation, has not been explored. OBJECTIVE The purpose of this study was to investigate perceptions of safety in mental health transitions (hospital to community) amongst five stakeholder groups. DESIGN AND SETTING An online, international cross-sectional, open-ended questionnaire. PARTICIPANTS There were five stakeholder participant groups: service users; families/carers; mental health-care professionals; researchers; and end users of research. RESULTS Ninety-three participants from 12 different countries responded. Three overarching themes emerged: 'individual/clinical', 'systems/services' and 'human, behavioural and social' elements of safe mental health transitions. Whilst there was a great focus on clinical elements from researchers and healthcare professionals, service users and carers considered safety in terms of human, behavioural and social elements of transitional safety (ie loneliness, emotional readiness for discharge) and systems/services (ie inter-professional communication). DISCUSSION Safety in mental health-care transitions is perceived differently by service users and families compared to healthcare professionals and researchers. Traditional safety indicators for care transitions such as suicide, self-harm and risk of adverse drug events are raised as important. However, service users and families in particular have a much wider perception of transitions safety. CONCLUSION Future quality and safety research and policy should consider including a service user voice and consider integration of psychosocial elements in discharge interventions.
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Affiliation(s)
- Natasha Tyler
- Faculty of Biology, Medicine and HealthNIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC)University of ManchesterManchesterUK
| | - Nicola Wright
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | - Maria Panagioti
- NIHR Greater Manchester Patients Safety Translational Research CentreUniversity of ManchesterManchesterUK
| | | | - Justin Waring
- Health Services Management CentreUniversity of BirminghamBirminghamUK
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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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Qian J, Qian M, Ren Y, Ye L, Qian F, Jin L, Chen L, Xu H. Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery. BMC Surg 2021; 21:121. [PMID: 33685424 PMCID: PMC7941921 DOI: 10.1186/s12893-021-01119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors. Methods A cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected. Results According to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05). Conclusion The level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.
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Affiliation(s)
- Jingyu Qian
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Miaofang Qian
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Yanyan Ren
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Linyan Ye
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Fangfang Qian
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Linlin Jin
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Lili Chen
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Haixia Xu
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 Zhongxing North Road, Shaoxing, 312000, Zhejiang, China.
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Facchinetti G, Albanesi B, Piredda M, Marchetti A, Ausili D, Ianni A, Di Mauro S, De Marinis MG. "The light at the end of the tunnel". Discharge experience of older patients with chronic diseases: A multi-centre qualitative study. J Adv Nurs 2021; 77:2417-2428. [PMID: 33591572 DOI: 10.1111/jan.14790] [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: 07/10/2020] [Revised: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. DESIGN Multi-centre descriptive qualitative study. METHODS Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. RESULTS Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. CONCLUSION Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. IMPACT Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.
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Affiliation(s)
- Gabriella Facchinetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.,Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, Tor Vergata University, Rome, Italy
| | - Beatrice Albanesi
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.,Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, Tor Vergata University, Rome, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Ianni
- Research Unit in Hygiene, Statistics and Public Health, Campus Bio Medico University Medical School, Rome, Italy.,Medical Directorate, Campus Bio-Medico University Hospital and Healthcare Facilities, Rome, Italy
| | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Harrison JD, Boscardin WJ, Maselli J, Auerbach AD. Does Feedback to Physicians of a Patient-Reported Readiness for Discharge Checklist Improve Discharge? J Patient Exp 2021; 7:1144-1150. [PMID: 33457557 DOI: 10.1177/2374373519895100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Limited data exist describing how hospital discharge readiness checklists might be incorporated into care. To evaluate how assessing patient readiness for discharge effects discharge outcomes. We assessed hospitalized adults' readiness for discharge daily using a checklist. In the first feedback period, readiness data were given to patients, compared to the second feedback period, where data were given to patients and physicians. In the first feedback period, 163 patients completed 296 checklists, and in the second feedback period, 179 patients completed 371 checklists. In the first feedback period, 889 discharge barriers were identified, and 1154 in the second feedback period (P = .27). We found no association between the mean number of discharge barriers by hospital day and whether data were provided to physicians (P = .39). Eighty-nine physicians completed our survey, with 76 (85%) recalling receiving checklist data. Twenty-three (30%) of these thought the data helpful, and 45 (59%) stated it "never" or "rarely" highlighted anything new. Patients continued to report discharge barriers even when physicians received patient-reported data about key discharge transition domains.
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Affiliation(s)
- James D Harrison
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - W John Boscardin
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Judith Maselli
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
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Post-operative discharge education for parent caregivers of children with congenital heart disease: a needs assessment. Cardiol Young 2020; 30:1788-1796. [PMID: 32959751 DOI: 10.1017/s1047951120002759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with congenital heart disease (CHD) have complex unique post-operative care needs. Limited data assess parents' hospital discharge preparedness and education quality following cardiac surgery. The goals were to identify knowledge gaps in discharge preparedness after congenital heart surgery and to assess the acceptability of an educational mobile application to improve discharge preparedness. METHODS Telephonic interviews with parents of children with two-ventricle physiology who underwent cardiac surgery 5-7 days post-discharge and in-person interviews with clinicians were conducted. We collected parent and clinician demographics, parent health literacy information and patient clinical data. We analysed interview transcripts using summative content analysis. RESULTS We interviewed 26 parents and 6 clinicians. Twenty-two of the 26 (85%) parents felt ready for discharge; 4 of the 6 (67%) clinicians did not feel most parents were ready for discharge. Fifteen of the 26 parents (58%) reported receiving the majority of discharge teaching on the day of discharge. Eight parents did not feel like all of their questions were answered. Most parents (14/26, 54%) preferred visual educational learning aids and could accurately describe important aspects of care. Most parents (23/26, 88%) and all 6 clinicians felt a mobile application for post-operative care education would be helpful. CONCLUSIONS Most parents received education on the day of discharge and could describe the information they received prior to discharge, although there were some preparedness gaps identified after discharge. Clinicians and parents varied in their perceptions of the readiness for discharge. Most responses suggest that a mobile application for discharge education may be helpful for transition to home.
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Chau JPC, Lo SHS, Lee VWY, Yiu WM, Chiang HCY, Thompson DR, Lau AYL. Fostering gerontology students' competence in Interprofessional collaborative practice. BMC MEDICAL EDUCATION 2020; 20:388. [PMID: 33109173 PMCID: PMC7592570 DOI: 10.1186/s12909-020-02273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interprofessional collaborative practice (IPCP) is increasingly recognised as being crucial for the provision of holistic care and optimising health outcomes among older adults, many with multiple complex health problems. However, little is known about the challenges of facilitating this in practice. Therefore, this study explores these issues from the perspective of different healthcare professionals and how this might inform interprofessional education curricula. METHODS Sixteen different healthcare professionals working in a variety of aged care (acute, rehabilitative and community) settings were invited to participate in individual semi-structured in-depth interviews designed to: (i) explore the meaning of IPCP; (ii) explore the facilitators of and barriers to IPCP; and (iii) examine the opportunities and challenges in interprofessional gerontological education. All interviews were tape-recorded and transcribed verbatim with thematic analysis conducted by two independent researchers. RESULTS Three major themes emerged from the interviews: the need for IPCP; role preparedness, scope and liability; and strategies for interprofessional education. Respondents shared a common belief that IPCP improves the quality of life of older adults in both hospital and community settings by improving person-centred coordinated care and decision making in care planning. However, respondents perceived major barriers to IPCP to be lack of knowledge about healthcare professionals' scope of practice, lack of training in interprofessional collaboration, professional culture and stereotypes, and liability issues. Suggested approaches to overcome these barriers included innovative teaching and learning approaches, engaging students early on in the curriculum of health professional degree programmes, and enhancing collaborative effective communication in health and social care settings. CONCLUSIONS It is anticipated that these findings will be used to inform the development of a new interprofessional gerontological education curriculum that aims to enhance students' competence in IPCP.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR.
| | - Vivian Wing Yan Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Wai Ming Yiu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Helen Chung Yan Chiang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
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Survivors of Critical Illness and Their Relatives. A Qualitative Study on Hospital Discharge Experience. Ann Am Thorac Soc 2020; 16:1405-1413. [PMID: 31394924 DOI: 10.1513/annalsats.201902-156oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: To target rehabilitation needs of survivors of critical illness and their relatives in a timely and adequate manner, a thorough needs assessment is recommended when hospital discharge planning is initiated. In light of existing evidence on physical and psychological consequences of critical illness for patients and family, it is currently unclear if current hospital discharge procedures suffice to meet the needs of this group.Objectives: To explore hospital discharge experience and to identify perceived barriers and enablers for a positive transition experience from hospital to home or rehabilitation facility as perceived by survivors of critical illness and their families.Methods: We performed a grounded theory study with semi-structured interviews among a group of survivors of critical illness and their relatives (n = 35) discharged from 16 hospitals across the Netherlands. Interviews were audio recorded and transcribed verbatim. Using constant comparative methods, initial and focused coding was applied to the data, which were further labeled into major categories and subcategories, ultimately leading to the identification of key concepts. Triangulation was applied through several reflexivity meetings at different stages of the study.Results: Twenty-two former intensive care unit patients and 13 relatives were interviewed. The mean age was 53 (standard deviation ± 11.2) and 60% were female. Median intensive care unit and hospital length of stay were 14 days (interquartile range, 9.75-24.5) and 35 days (interquartile range, 21.75-57.25), respectively. Thematic analyses led to identification of seven key concepts, representing barriers and enablers to a positive transition experience. "Existing in a fragmented reality," "being overlooked," and "feeling disqualified" were identified barriers and "feeling empowered," "encountering empathic and expert professionals," "managing recovery expectations," and "family engagement" were identified as enablers for a positive perceived transition experience.Conclusions: Findings of this study suggest that current hospital discharge practice for survivors of critical illness is driven by speed and efficiency, rather than by individual needs assessments, despite advocacies for patient- and family-centered care. Discharge strategies should be customized to facilitate adequate and comprehensive assessment of aftercare needs, conducted at the right time and within the right context, encouraging empowerment and a positive perceived transition from hospital to home.
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Hua W, Yuwen W, Simoni JM, Yan J, Jiang L. Parental readiness for hospital discharge as a mediator between quality of discharge teaching and parental self-efficacy in parents of preterm infants. J Clin Nurs 2020; 29:3754-3763. [PMID: 32644290 DOI: 10.1111/jocn.15405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self-efficacy in parents of preterm infants. BACKGROUND Parental readiness for hospital discharge and self-efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High-quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self-efficacy. DESIGN This was a descriptive cross-sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. METHODS The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale-Parent Form, and Preterm Parenting and Self-Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. RESULTS Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self-efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self-efficacy by improving parental readiness for discharge. CONCLUSIONS Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self-efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self-efficacy. RELEVANCE TO CLINICAL PRACTICE Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jie Yan
- Neonatology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Chief Nursing Officer, Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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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