Broadening the Horizons on Predictors of Discharge Teaching, Discharge Readiness, and Postdischarge Outcomes

Abstract

Paper Presentation Objective To explore the predictors of postpartum mothers' perceptions of the quality of discharge teaching, readiness for hospital discharge, and associated outcomes with postdischarge coping difficulty and use of health care. Design An exploratory research design was used to identify relationships among intrapartum and postpartum variables on postdischarge coping difficulty and use of health care. Setting Southwestern women's specialty hospital with 209 beds. Sample A powered sample size of one 185 English and Spanish speaking, mixed parity, postpartum mothers who had vaginal or cesarean births of healthy infants were included in the sample. Methods A conceptual model adapted from the middle range theory of Meleis provided a framework for exploring transition concepts relevant to postpartum mothers going home. Participants completed a demographic questionnaire that included items related to the nature of transition and transition conditions that affect patterns of response during labor and postpartum. These mothers also completed a quality of discharge teaching questionnaire and readiness for hospital discharge questionnaire prior to discharge. Discharge teaching was the pattern of response under investigation during hospital transition from to home. Postdischarge coping questionnaires to measure coping difficulty and collect information on health care use were completed at home by the participants and were the end outcomes of the patterns of response. Results Gestational age, maternal education, and number of children were predictive of postpartum mothers' perceptions of the quality of discharge teaching. Maternal/infant length of stay, delivery mode, and the quality of discharge teaching were predictive of the readiness for hospital discharge; 26% of the variance was explained by the quality of discharge teaching. Readiness for hospital discharge, particularly the physical status of the participants, accounted for 27% of the variance in postdischarge coping difficulty. Information needed and nurses' delivery of discharge teaching were also predictive of postdischarge coping difficulty and use of health care services. Patient demographics, delivery of information, and key educational content themes emerged from the qualitative responses that reinforced the quantitative findings. Conclusion/Implications for Nursing Practice These data provide evidence of the critical role of the nurse in educating patients and families to facilitate a smooth transition home after childbirth.