| Objective:(1)To develop an evaluation scale of discharge readiness for peritoneal dialysis patients in China.(2)The feasibility,reliability,validity and reactivity of the scale were tested.(3)To investigate the clinical effect of this scale.Methods:(1)This study referred to the Readiness for Hospital Discharge Scale prepared by Weiss et al,and constructed a pool of 41 items of the scale through literature analysis,patient interviews and group discussions.Then through the Delphi method preliminary screening and modification of the items,the pre-scale.Then 20 patients with abdominal dialysis were selected for the purpose of a preliminary survey to further revise and improve the preliminary scale.(2)The abdominal penetration center of a grade a hospital in Guizhou province was sampled in two stages.Stage 1:From January to June 2019,220 hospitalized patients with abdominal ventilation were investigated by using the preliminary scale and the self-made general information questionnaire.With Epidata3.1 software to establish the database and the data import SPSS26.0 software,comprehensively using discrete degree method,differentiation method,correlation coefficient method and exploratory factor analysis method analysis and selection entries,and established by exploratory factor analysis of entry and dimension structure,get the peritoneal dialysis patients discharged from hospital readiness assessment scale;Stage 2:From July to November 2019,200 patients with abdominal dialysis were investigated by using the self-made patient general information questionnaire and peritoneal dialysis patients’ discharge readiness assessment scale.AMOS25.0 software was used for confirmatory factor analysis to test the validity of the scale structure.The content validity of the scale was analyzed by expert evaluation method,and the reliability of the scale(homogeneous reliability and fractional half-reliability)was analyzed by SPSS26.0 software.(3)The 200 patients investigated in the second stage were numbered in the order of the time when the scale was issued.Those with odd Numbers were in the control group,and those with even Numbers were in the observation group,with 100 patients in each group.To analyze and compare the general data and discharge readiness scores of the two groups,there were no statistical differences(P<0.01 or P<0.05).Patients in the control group received routine care in the abdominal penetration center.Observation group of patients on the basis of conventional nursing,the implementation of hospital preparation according to the results of the discharge readiness survey service intervention,on the day of discharge from hospital again using questionnaire survey,evaluation questionnaire of reaction degree and the two groups of patients at the end of a discharge of abdominal complications and hospitalization rate,rate of outpatient visit regularly and abdomen through dropout rates have statistical difference(P<0.01 or P<0.05).Results:(1)Item analysis and filtering results:After expert consultation,pre-survey and quantitative statistical analysis,16 items were deleted,1 item was added,2 items were merged,10 items were modified and the remaining 25 items were left.The cumulative variance contribution rate of the four factors extracted was 59.440%,so a scale with 25 items in four dimensions was finally formed,namely:personal status(7 items),peritoneal dialysis knowledge reserve(10 items),social support(4 items)and post-discharge coping ability(4 items).All the items were scored on a level 5 scale of 0-4,and no reverse items were set in the scale.The sum of the cumulative scores of each item was the total score of the scale,which ranged from 0-100.The higher the score,the better the patient’s readiness for discharge.(2)Scale feasibility,reliability,validity and responsiveness:Scale feasibility:The recovery rate of the scale was 95.24%,the completion rate was 100%,the longest time was 17 minutes,the shortest time was 7 minutes,the average time was 11.45±2.97 minutes.Scale reliability:①Homogeneity reliability:Cronbach’s coefficients of the total scale and each dimension were 0.909,0.899,0.787,0.737 and 0.768;②Split-half reliability:The total scale and the half-breaking coefficients of each dimension are 0.727,0.890,0.485,0.752 and 0.762.Scale validity:①Content validity:The positive coefficients of the two rounds of expert consultation were 90.5%and 100%,the authoritative coefficients were 0.88 and 0.90,and Kendall’s W values were 0.608 and 0.312.It indicates that experts have high enthusiasm,authority and good coordination.After experts consult,the items are clearly expressed,easy to understand and can accurately reflect the concept to be measured,so as to ensure that the scale has a good content validity;②Structural validity:Confirmatory factor analysis results showed that the approximate error root mean square(RMSEA)was 0.070.The value added fitting index(IFI),turkey-lewis index(TLI)and comparison fitting index(CFI)were 0.915,0.901 and 0.914,respectively.The ratio of chi square test to degree of freedom(x2/df)was 1.969,which reached the standard.Scale responsiveness:In the observation group,after the implementation of discharge readiness service intervention,the total score of discharge readiness and the score of the four dimensions were all increased.The effect scale of the scale was 1.17.After the paired t test,t=-24.361,P<0.01,indicating that the scale could distinguish the improvement of patients’ discharge readiness before and after the discharge readiness service intervention.(3)Preliminary clinical application effect of the scale:There was no statistically significant difference in the general data and discharge readiness scores between the two groups before the discharge readiness service intervention(all P>0.05).After the intervention(At the end of 1 month after discharge from the hospital both groups),the incidence rate of abdominal transparency complications(1.03%),rehospitalization rate(1.03%)and abdominal transparency withdrawal rate(0%)of patients in the observation group were all lower than those in the control group(7%,6.12%and 3.06%),and the outpatient regular revisit rate(97.94%)was higher than those in the control group(82.65%),(P<0.01).Conclusion:(1)The "discharge readiness assessment scale for PD patients" compiled in this study contains 25 items in four dimensions,including individual status,peritoneal dialysis related knowledge reserve,social support and post-discharge coping ability.(2)The scale has good feasibility,reliability,validity and reactivity,and can be used to evaluate the discharge readiness of patients with abdominal dialysis.(3)According to the evaluation results of the scale,the implementation of targeted discharge preparation service intervention for patients with abdominal dialysis can reduce the incidence of complications,readmission rate and withdrawal rate of abdominal dialysis treatment,and significantly improve the rate of outpatient regular revisit.The scale has certain clinical application value. |
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