Study On Discharge Readiness Of Patients With Chronic Obstructive Pulmonary Disease Complicated With Respiratory Failure And Its Influencing Factors

ObjectiveIn this study,we investigated the status and influencing factors of discharge readiness in COPD patients with respiratory failure,and analyzed the correlation between social support,anxiety,depression,self-management and discharge readiness.To investigate the chain-mediated effects of anxiety,depression and self-management on social support and discharge readiness in COPD patients with respiratory failure.Through this study,we hope to provide a theoretical basis for improving the perception of discharge of COPD patients with respiratory failure and formulate reasonable discharge plan,so as to improve the level of discharge readiness of patients.Methods1.From January to September 2022,we selected COPD patients with combined respiratory failure who met the criteria of this study in the Department of Respiratory and Critical Care Medicine at a Level 3 A General Hospital in Hohhot City using a convenient sampling method.Tools used in the study include: General Information Questionnaire(GIQ),Social Support Scale(SSRS),Hospital Anxiety,Depression Scale(HADS),COPD Self-Management Scale,and Readiness to Discharge Measure(RHDS).2.Data analysis was performed by SPSS 26.0 using Epidata 3.0,a database created for this study.In this study,we used frequency,ratio,and mean ± standard deviation to describe general data,t-testing and multivariate linear regression analysis of two variance homologies,two independent samples to analyze relevant factors affecting discharge readiness,Pearson correlation analysis to explore associations between social support,anxiety,depression,self-management and discharge readiness,and Amos 23.0 software to build mediating effect models to better understand the relationship between patient discharge readiness and social support.Results1.After descriptive analysis,COPD patients with combined respiratory failure had a lower overall discharge readiness score(75.22 ± 18.88),with lower individual status(19.96 ±5.34),predictive support(24.93 ± 7.06),adaptability(30.33 ± 9.69),and all three dimensions.The overall score for social support was(36.24 ± 8.51),which was medium,with three dimensions scoring from high to low: subjective support(21.13 ± 4.91),objective support(8.03 ± 3.05),and support for utilization(7.08 ± 2.23).The overall score for self-management(144.4 ± 29.95)was medium,with five dimensions scoring: symptom management(23.06 ±5.87),daily life management(39.70 ± 9.30),mood management(35.23 ± 8.70),information management(21.60 ± 6.00),and self-efficacy(24.82 ± 6.42).Anxiety and depression were scored(16.14 ± 6.04),with anxiety dimension(8.09 ± 3.31)and depression dimension(8.05 ±3.32).2.After a single-factor ANOVA and t-test analysis of two independent samples,we found that age,education,occupation,marital status,monthly household income,lifestyle,knowledge of the disease,disease severity,and respiratory difficulty ranking all had statistically significant differences in readiness for discharge in COPD patients with respiratory failure(P < 0.05).3.Multivariate linear regression analysis showed that six variables,including monthly household income,residence style,social support,self-management,anxiety,and depressed mental state,were the main factors affecting readiness for discharge in COPD patients with respiratory failure,accounting for 53.9% of the total variation.4.According to Pearson correlation analysis,discharge readiness was positively correlated with social support(r = 0.508,P < 0.05);discharge readiness was positively correlated with self-management(r = 0.614,P < 0.05);discharge readiness was negatively correlated with anxiety depression(r =-0.463,P < 0.05);social support was negatively correlated with anxiety depression(r =-0.270,P < 0.05);and social support was positively correlated with self-management(r = 0.505,P < 0.05).5.Using Amos23.0 software to model the chain-structure equation,we found that psychological state and self-management had a chain-mediated effect between social support and discharge readiness in COPD patients with respiratory failure,with a good fit,with an intermediate effect value of 0.435 and an overall indirect effect of 70.3%.Conclusion1.In general demographics,age,education,occupation,marital status,monthly household income,residence patterns,knowledge of the disease,severity of illness,and respiratory difficulty ranking had an impact on readiness for discharge in COPD patients with respiratory failure.2.COPD patients with combined respiratory failure scored medium for social support,anxiety,depressed mental state,self-management ability,and low discharge readiness,with significant room for improvement.3.Among COPD patients with combined respiratory failure,there were two correlations:social support,anxiety,depressive mental state,self-management ability and discharge readiness.In addition to the negative correlation between anxiety,depressive mental state and other factors,three other factors showed significant positive correlation.4.Anxiety,depression and self-management function as a chain mediator between social support and readiness for discharge in COPD patients with respiratory failure,suggesting that by improving the psychological status of COPD patients with respiratory failure,improving their self-management ability and promoting their use of social support,the patient’s readiness for discharge can be improved.