Elsevier

Journal of Pediatric Nursing

Volume 34, May–June 2017, Pages 58-64
Journal of Pediatric Nursing

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

https://doi.org/10.1016/j.pedn.2016.12.021Get rights and content

Highlights

  • High quality discharge teaching contributes to better parent discharge readiness.

  • How nurses teach is more influential than the amount of content taught.

  • Nurse assessment of parent discharge readiness is a predictor of readmission.

  • Parents who are more ready for discharge have less post-discharge coping difficulty.

  • Improving nurses' teaching skills may improve parent and child outcomes.

Abstract

Purpose

This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits).

Design/methods

In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3 weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits).

Results

Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B = 0.54) and nurse assessment (B = 0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B =  0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%.

Conclusion

There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission.

Practice Implications

Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions.

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.

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