: Purpose : The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients’ perceptions of their readiness for hospital discharge. Design : A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting : Midwestern tertiary medical center. Sample : 147 adult medical-surgical patients. Methods : Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings : Living alone, discharge teaching (amount of content received and nurses’ skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions : Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis’ transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice : The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes. With the contemporary focus on minimizing length of hospital stay, patients are discharged in an intermediate rather than complete stage of recovery.

/pdf/perceived-readiness-for-hospital-discharge-in-adult-medical-2rqatrbde8.pdf

Perceived readiness for hospital discharge in adult medical-surgical patients.

/pdf/helping-elderly-persons-in-transition-a-framework-for-2q2gz11wwn.pdf

Helping Elderly Persons in Transition: A Framework for Research and Practice

Fatigue is a complex symptom prevalent in informal caregiving. When role demands exceed caregiver resources, fatigue ensues and caregiving can be compromised. The purpose of this study was to compare perceptions of fatigue among older adults (N = 92) caring for spouses with Alzheimer's disease, Parkinson's disease, or cancer with a control group of older adults (N = 33) whose spouses required no extra care. Caregiving elders reported more fatigue, less energy, and more sleep difficulty than did control participants. All caregiving groups reported similar levels of fatigue, energy, sleep, and self-reported health even though there were marked differences regarding spousal status. Health care providers can support older caregivers in monitoring their own health and in recognizing the need for services that support the caregiving role.

Fatigue among elders in caregiving and noncaregiving roles.

Aims. To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan.

Background.  Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families.

Design.  A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers.

Methods.  The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale.

Results.  Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs.

Conclusions.  This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge.

Relevance to clinical practice.  This caregiver-oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers’ preparation and the satisfaction of their needs during the discharge transition.

A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers.

Background. Review of the literature reveals a need to develop a questionnaire that measures patient perceptions of factors impacting continuity of care following discharge from hospital. Such a measure has the potential to guide quality improvement initiatives related to continuity of care. Objective. Our objective was to develop and examine the psychometric properties of a measure that would meet this need, the Patient Continuity of Care Questionnaire (PCCQ). Method. The PCCQ was administered to 204 inpatients 4 weeks after discharge. The questionnaire was assessed by item and principal components analysis. Factors derived from principal components analysis were assessed for internal consistency and construct validity.

Patient perceptions of hospital discharge: reliability and validity of a Patient Continuity of Care Questionnaire

The purpose of this study was to test a model of factors influencing family caregivers' responses and health outcomes during the 2-month period following an elder's discharge from the hospital for acute episodes of chronic illness. The elder's average age was 72.3 years. The average age of caregivers, 63% of whom were spouses of the elder, was 61 years. A longitudinal design was used for this study. Data were collected from 346 elder/caregiver dyads the day before discharge and at 2 weeks and 2 months postdischarge. Structural equation analysis was used to evaluate the conceptual model. The findings suggest that the model fits the data with an overall Goodness of Fit Index of .80.

Testing a model for posthospital transition of family caregivers for elderly persons

Continuity of care is a critical component of quality patient care, yet the paucity of reliable and valid measures of continuity of care make it difficult to ascertain the extent to which continuity has been achieved. The purpose of this article is to describe the development of an instrument to measure continuity of care that incorporates the perspectives of elders hospitalized for a chronic illness and their family caregivers. The instrument was used, and its reliability and validity examined, in a series of studies related to elders' posthospital transition. Elders in the studies ranged in age from 55 to 94 years. The findings supported content and construct validity, internal consistency reliability, and ability to detect changes in the same subjects at different points in time for the care management and services subscales. With further refinement, the continuity of provider and conflicting information subscales might also facilitate assessment of care continuity.

Measuring continuity of elders' posthospital care.

The purpose of this study was to examine the effect of family caregivers' perceptions of elders' behaviors on caregiver burden and health while controlling for other factors often associated with burden. The model tested included the following concepts: elders' health, caregivers' perceptions of elder behaviors, caregiving involvement, coping, discrepancy in social support, caregiver response and caregiver health. Data for the analyses were obtained from a longitudinal study of 346 elder/caregiver dyads in which the elders had been hospitalized for acute episodes of chronic conditions. The sample for these analyses consisted of a subset of 118 dyads from the longitudinal project. A structural equation approach using the computer software Linear Structural Relations (LISREL) was used in analyzing the data. The findings indicated that the data fit reasonably well with some of the general patterns hypothesized in the model; the Goodness of Fit Index was 0.85 and the Tucker-Lewis Fit index, .88. More important than overall fit were specific relationships. Caregivers' perception of elders' behaviors was directly linked with caregiving response two weeks postdischarge; caregiver response directly linked with caregiver health at two weeks postdischarge but not at two months postdischarge. The findings provide support for Lazarus and Folkman's theory that appraisal of the situation influences response.

Testing a model of family caregivers' perceptions of elder behavior two weeks posthospitalization on caregiver response and health.

Many instruments have been developed with college students and used primarily with students or younger adults. Thus, researchers face challenges in selecting measures of psychological state that are valid and reliable for use with elders. This article describes a measure of psychological state, the Symptom Questionnaire; provides information about its reliability and validity; and details the steps used to evaluate reliability and validity of its anxiety and depression scales for elders hospitalized for an acute episode of a chronic condition. The findings suggest that a short version of the Symptom Questionnaire, consisting of the depression and anxiety scales, is valid and reliable for elders. The findings also revealed small differences between the means of data collected using the short version and those obtained using the full instrument.

Symptom Questionnaire anxiety and depression scales: reliability and validity.

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Testing a model for posthospital transition of family caregivers for elderly persons

Measuring continuity of elders' posthospital care.

Testing a model of family caregivers' perceptions of elder behavior two weeks posthospitalization on caregiver response and health.

Symptom Questionnaire anxiety and depression scales: reliability and validity.