Survey Of The Readiness For Hospital Discharge And Its Influencing Factors Among Coronary Heart Disease(CHD) Patients

Objectives: Patients' perception of discharge readiness is important to patients' safety and recovery at home.Evaluation is the first step of the nursing process,scientific and effective assessment is premise to providing care services.The purposes of this study were to describe the status of CHD patients' readiness for hospital discharge and to explore the influence of demographic data,disease-related variables and the quality of discharge teaching on the patients' discharge readiness.Methods: This study contains two major steps:the development of questionnaire and cross-sectional surveyStep 1-Development of the questionnaire: The main components of the questionnaire and the measurement tools were determined according to the purpose of the study.The "General Information " part contains patients' demographic information and disease-related variables designed by literature review and panel discussion.Patients' readiness for discharge was calculated using the Chinese version of the Readiness for Hospital Discharge Scale(RHDS)by professor Lin from Taiwan.And the Quality of Discharge Teaching Scale(QDTS)was introduced to measure the discharge teaching variables that might affect patients' discharge readiness.Based on the process of translation,back-translation,culture adaption,expert consultation and pre-test to get the draft,and then chose 167 inpatients from a tertiary general hospital in Wuhan to test the reliability and validity of the Chinese version scale.Step 2-Cross-sectional survey: Collecting the data from 4 tertiary general hospitals in Wuhan by questionnaire.Selecting the patients according to the inclusion and exclusion criteria and obtaining the informed consent.SPSS19.0 and SAS9.4 software were used to analyze the data.Descriptive analysis was used to describe the status of CHD patients' discharge readiness.Using methods of univariate analysis,correlation analysis and multiple stepwise regression analysis identified the impact factors of CHD patients' perception of discharge readiness.Results:1.Revision and psychometric test of Chinese version-Quality of Discharge Teaching Scale(QDTS): QDTS is consisted of 24 items and 3 subscales(Content Needed,Content Received and Delivery of discharge teaching),which could explain 65.38% of the total variance.The Cronbach's ? coefficients of the total scale and 3 factors were0.92,0.88~0.94;the Guttman-split half reliability was 0.85.The S-CVI/Ave value was 0.98 and all of the computed I-CVI values were greater than 0.80.2.Results of descriptive analysis and univariate analysis of RHDS for patients with CHD: The mean total score of RHDS in this study was(96.15 � 17.30),among which there were 38 cases(9.20%)scored 14-71 points,146 cases(35.35%)scored 72-96 points,and 229 cases(55.45%)scored 97-120 points;The standardized scores in the three subscales were: personal status(7.57 � 1.82),adaptive ability(8.25 � 1.65),and expected support(8.05 � 1.70).Univariate analysis showed that education levels,work status,income,days for hospitalization,long-term regular medication,regular follow up,perception of self-care ability,whether have friends with the same disease,numbers of comorbidity and numbers of medicine were related to RHDS(P <0.05).3.The scores of QDTS and its correlation with RHDS: In the study,the patients rated QDTS(141.53�31.34),while the standardized scores were higher for the Delivery subscale(8.19�1.60)than for the Content Received subscale(7.21�2.34);There were statistically significant relativity between RHDS score and both total scale score and all the subscale scores of QDTS(P <0.001).4.Results of multiple stepwise regression analysis for CHD patients : A total of 6variables were finally entered into the regression equation,which could account for42.6% of the variance in RHDS scores.The standardized effect of partial regression coefficient were: the scores of QDTS,the perception of self-care ability,long-term regular medication,income,the number of comorbidities and the work state of retired.Conclusions:1.The Chinese version of QDTS is reliable and valid,and may be used for the assessment and measurement of the quality of discharge teaching in Chinese.2.The RHDS scores among CHD patients were medium-high,which reflect most of the study subjects as reasonably ready for discharge and had enough capacity of post-discharge coping as well as adequate social supports,while still need further rehabilitation at home.3.The low perception of self-care ability and the long-term regular medication lead to low RHDS scores.Patients with more complications had lower scores of discharge readiness;The retired patients' RHDS scores were higher than those who were never employed;Patients with high-quality of discharge teaching and high income had higher perception of discharge readiness.4.The QDTS is closely related to the RHDS,and discharge teaching can be effectively interfered,which suggested clinicians should pay more attention to the discharge teaching,ensure the quality of discharge teaching so as to improve the patients' preparation for hospital discharge.5.The research idea and the instruments of this study maybe useful to screening out patients with high-risk in readmission in future clinical work,and providing guidance for developing and selecting targeted intervention strategies.It had an important practical significance on improving patients' overall level of discharge readiness with CHD,relieving patients' disease uncertainty,and helping hospitals carry out a more scientific transitional care service.