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Chen C, Sun Y, Chen C, Zhang M, Lin S, Dai T, Li R, Huang J, Zheng J, Chen Y. Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT). J Perianesth Nurs 2024; 39:195-201.e3. [PMID: 38099885 DOI: 10.1016/j.jopan.2023.07.012] [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: 11/12/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE To ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients' discharge readiness evaluation. DESIGN This is a methodological study. METHODS The development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study. FINDINGS The final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99. CONCLUSIONS The Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.
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Affiliation(s)
- Chen Chen
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiwen Sun
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Caifen Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengyue Zhang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shudan Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingting Dai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiali Huang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingwei Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanyan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Bristol AA, Elmore CE, Weiss ME, Barry LA, Iacob E, Johnson EP, Wallace AS. Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge. BMJ Qual Saf 2023; 32:447-456. [PMID: 36100445 PMCID: PMC10512519 DOI: 10.1136/bmjqs-2022-015120] [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: 04/28/2022] [Accepted: 08/13/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Intrahospital transitions (IHTs) represent movements of patients during hospitalisation. While transitions are often clinically necessary, such as a transfer from the emergency department to an intensive care unit, transitions may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals. However, carers frequently experience exclusion from care planning during IHTs, potentially decreasing their awareness of patients' clinical status, postdischarge needs and carer preparation. The purpose of this study was to explore family carers' perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care. METHODS Sequential, explanatory mixed-methods study involving retrospective analysis of hospital inpatients from a parent study (1R01HS026248; PI Wallace) for whom patient and family carer Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. Maximum variation sampling was used to recruit a subsample of carers with diverse backgrounds and experiences for the participation in semistructured interviews to understand their views of how IHTs influenced preparation for discharge. RESULTS Of discharged patients from July 2020 to April 2021, a total of 268 had completed the RHDS and 23 completed the semistructured interviews. Most patients experienced 0-2 IHTs and reported high levels of discharge readiness. During quantitative analysis, no association was found between IHTs and patients' RHDS scores. However, carers' perceptions of patient discharge readiness were negatively associated with increased IHTs. Moreover, non-spouse carers reported lower RHDS scores than spousal carers. During interviews, carers shared barriers experienced during IHTs and discussed the importance of inclusion during discharge care planning. CONCLUSIONS IHTs often represent disruptive events that may influence carers' understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning.
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Affiliation(s)
- Alycia A Bristol
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Catherine E Elmore
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Marianne E Weiss
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Lisa A Barry
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Eli Iacob
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Erin P Johnson
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Andrea S Wallace
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
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Topham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag 2022; 27:181-193. [PMID: 35617533 PMCID: PMC9177052 DOI: 10.1097/ncm.0000000000000563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes. METHODS We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy. RESULTS Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps. CONCLUSION The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes. IMPLICATIONS FOR CASE MANAGEMENT This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
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Affiliation(s)
- Emily Wahlquist Topham
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Alycia Bristol
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Brenda Luther
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Catherine E Elmore
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Erin Johnson
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Andrea S Wallace
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
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You H, Lei A, Li X, Liao X, Chang J. Discharge teaching, patient-reported discharge readiness and postsurgical outcomes in gynecologic patients undergoing day surgery: a generalized estimating equation. BMC Surg 2022; 22:166. [PMID: 35538567 PMCID: PMC9092867 DOI: 10.1186/s12893-022-01607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gynecologic patients undergoing day surgery are discharged in an intermediate stage of recovery. The quality of discharge teaching and discharge readiness are important to patients’ postsurgical outcomes, but little research has focused on them. Methods Quality of discharge teaching and discharge readiness were measured, and Spearman correlations were conducted. Postsurgical outcomes were recorded on postoperative Day 1, postoperative Day 7, and postoperative Day 28. Generalized estimating equations were used to explore factors that influence postsurgical outcomes. Results Discharge teaching was verified to be positively correlated with the discharge readiness of participants. The generalized estimating equations indicated that discharge teaching skills, effects of doctors and nurses, patient-reported physical conditions and social support following discharge were protective factors for postsurgical outcomes. Conclusions Doctors and nurses should improve discharge teaching skills and effects to improve the postsurgical outcomes of gynecological patients undergoing day surgery. At discharge, doctors and nurses should assess patients’ physical condition and facilitate a social support system.
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Affiliation(s)
- Huaxuan You
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Anjiang Lei
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xin Li
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Xu Liao
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Jing Chang
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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