The health literacy and patient discharge experience dyad after cardiac surgery: an exploratory study

Perceived stress, positive psychological capital and health literacy in patients with multiple chronic conditions: A structural equation modelling

AIM

To investigate the structural relationships among perceived stress (PS), positive psychological capital (PsyCap) and health literacy (HL) in patients with multiple chronic conditions (MCC) and construct a model to explore the relationships of PS and PsyCap on HL.

BACKGROUND

HL is critical in the rehabilitation and management of patients with MCC. Extensive understanding of the relationships between research variables can help nursing staff to implement effective programmes that improve the level of HL of patients. However, currently there is no research that has evaluated the structural relationships among these variables using a single model.

METHODS

This study adhered to the STROBE guidelines for reporting cross-sectional studies. The Health Literacy Scale for Chronic Patients, Chinese Perceived Stress Scale (CPSS) and Positive Psychological Capital Questionnaire were used to assess HL, PS and PsyCap, respectively. Questionnaires were distributed to 317 patients with MCC attending a tertiary general care hospital in China from February to May 2023, using convenience sampling approach. Structural equation modelling was used to validate the proposed model.

RESULTS

The findings showed that PS has a negative relationship with HL and PsyCap. PS was indirectly associated with HL through PsyCap. The results indicated that PsyCap was positively associated with HL. The PS and PsyCap explained 64% of the variance in HL.

CONCLUSIONS

The findings showed that the proposed model had high validity and structural relationships between chosen variables were observed for MCC patients.

RELEVANCE TO CLINICAL PRACTICE

These results may help nursing staff develop strategies to improve the HL of patients with MCC, which should focus on reducing PS and enhancing PsyCap to improve HL. Nursing staff can provide targeted psychological counselling and health guidance for patients to alleviate negative emotions and further promote their HL.

PATIENT OR PUBLIC CONTRIBUTION

Participate in research and fill out questionnaires.

Thrown in at the deep end: a qualitative study with physicians on the purpose and challenges of discharge interviews

OBJECTIVES

Against the backdrop of poor discharge communication in hospitals, this study explores the purpose of discharge interviews from the physicians' perspective and the challenges they are confronted with. Discharge interviews are legally required in Germany as part of the discharge management. Led by the ward physician, the discharge interview should summarize relevant information about the hospital stay, medication, lifestyle interventions and follow-up treatment.

METHODS

Semi-structured interviews with n = 12 physicians were conducted at Heidelberg University Hospital between February and April 2020. Qualitative content analysis was carried out using MAXQDA.

RESULTS

Physicians reported gaining information, providing information, and answering open-ended questions as the purpose of the discharge interview. Challenges in conducting discharge interviews were related to finding a common language, patient-related challenges, conditions of everyday ward life, and lack of training. Physicians reported receiving no explicit training on discharge interviews. While professional experience seems to mitigate the lack of training, some physicians expressed a prevailing sense of insecurity.

CONCLUSION

The lack of preparation for discharge interviews in medical school makes it particularly challenging for physicians to translate their theoretical knowledge into patient-centered discharge communication. Medical training on discharge interviews should be expanded in terms of theoretical input on the ideal content, its purpose and potential (e.g. in reducing readmissions), as well as practical exercises.

Hospital Discharge Process: Context-Sensitive Care

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses' discharge practices to provide individualized care and to facilitate the hospital-to-home transition.