Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children
Section snippets
Theoretical Framework
The research was guided by two theoretical frameworks: The Individual and Family Self-Management Theory (IFSMT) (Ryan & Sawin, 2009) and Transitions Theory (Meleis, Sawyer, Im, Messias, & Schumacher, 2000). The use of these theories to conceptualize the relationships investigated in the study and the measures to study these relationships is presented in the conceptual-theoretical-empirical structure in Fig. 1.
The IFSMT focuses on the patient and family experience in self-management of health
Design
A longitudinal correlational design was used to address the study aim. This was a secondary analysis of data from a pilot study of a family self-management discharge preparation intervention. This original study compared pre-intervention baseline, (n = 90), intervention (n = 56), and concurrent control (n = 48) groups using a difference-in-differences analysis approach (Dimick & Ryan, 2014). There were no differences between the intervention and control groups on measures of quality of discharge
Results
One hundred and ninety-four patients completed study measures prior to discharge and had readmission data available. The 3 week post-discharge telephone interview for collection of outcome data on the PDCDS was completed by 150 parents.
Sample characteristics are presented in Table 1 for the sample at discharge (n = 194) and the portion of the sample that completed the PDCDS (n = 150). Parents/caregivers (n = 170 [88%) female parent, n = 18 [9.3%] male parent; n = 6 [3.1%] other, including grandparent)
Discussion
The results of this study point to the trajectory of influence of quality of discharge teaching to parental readiness for discharge and subsequent post-discharge coping difficulty and readmissions. While in general, quality of discharge teaching is rated highly, most parents are ready for discharge and have little difficulty coping after discharge, the results indicate that when quality of discharge teaching delivery is low, the cascade of effects leads to negative outcomes for parents and
Conclusions
There is a sequential cascade of effects that starts with the quality of discharge teaching delivery by the child's nurses on parent-reported discharge readiness, which is then associated with parent coping difficulty. Nurse assessment of discharge readiness, weakly but significantly associated with the quality of discharge teaching delivery, is a predictor of the likelihood of the child's readmission.
Funding
This work was supported by the Pediatric Nursing Research Consortium, a joint project of Children's Hospital of Wisconsin, University of Wisconsin Milwaukee College of Nursing, and Marquette University College of Nursing. Additional funds were provided by the Sophie Schroeder Endowed Chair for Nursing, held by Nancy Korom, Chief Nursing Officer and Vice President - Children's Hospital of Wisconsin
Acknowledgments
We would like to acknowledge the following for their contribution and support: study nurses, Jamie Thompson, Stacy Zodrow, Megan (Kroll) Ming, Elisa Gricunas, Holly Orlowski, Katie Junemann, Mary Biskupski, Maggie Fredericks, Amanda Mercado, Michelle Miklosh, Michelle Donlin, Jodi Neuwirth, Stephanie Essma, Molly Kaul, Cheryl Kornburger; Data entry staff Areyl Goff; Nurse Leaders on the study units: Eileen Sherburne, Kimberly Zimmanck, Amanda Quesnell, Stacy Zodrow; Data collection: the staff
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Cited by (0)
- 1
Currently at the College of Nursing-University of Wisconsin Milwaukee, United States.
- 2
Currently at Mennonite College of Nursing, Illinois State University, United States.