Coping Difficulty Research Articles

Coping difficulties after inpatient hospital treatment: validity and reliability of the German version of the post-discharge coping difficulty scale.

Patients transitioning between different care contexts are at increased risk of experiencing adverse events. In particular, being discharged to home after inpatient treatment involves significant risks. However, there is a lack of valid and internationally comparable assessment tools on patients' experiences of difficulties following hospital discharge. Therefore, this study aimed to adapt and validate the German version of the post-discharge coping difficulty scale (PDCDS-G). Patients were recruited at a German university hospital. 815 adult patients participated in a self-report survey following an inpatient stay of at least three days. Factorial validity of the PDCDS-G was evaluated via factor analyses. Further, examination of measurement invariance was performed. To establish criterion validity, associations with patients' self-reported health status and occurrence of patient safety were determined. Further, group differences regarding patient characteristics, hospitalization factors, and survey-related variables were examined. Factorial validity of the PDCDS-G was confirmed by a two-factorial model with good model fit. Both factors showed good to excellent reliability. The two-factor model achieved measurement invariance across all patient characteristics, hospitalization factors, and survey-related variables. Significant relationships with patients' health status and the occurrence of patient safety incidents corroborate criterion validity of the PDCDS-G. Differential associations of the two PDCDS-G factors regarding patient characteristics, hospitalization, and survey-related variables were found. Construct and criterion validity, as well as the reliability of the PDCDS-G, were verified. Further, instrument's measurement invariance was confirmed allowing use of the scale for the interpretation of group differences and comparisons between studies. The PDCDS-G provides a validated and comparable patient-reported outcomes measure for patient experiences after hospital discharge to home. The PDCDS-G can be used for patient surveys in quality or patient safety improvement in care transition processes.

The mediating effects of parenting self-efficacy between readiness for hospital discharge and post-discharge coping difficulty among mothers of preterm infants

Post-discharge coping difficulty presents a significant challenge for mothers of preterm infants. The readiness for hospital discharge and parenting self-efficacy are crucial factors influencing post-discharge coping difficulty. However, the pathways through which these factors impact post-discharge coping difficulty remain unclear. This study aims to investigate the impact of readiness for hospital discharge on post-discharge coping difficulty and the mediating role of parenting self-efficacy among mothers of preterm infants. A prospective study involving 462 mothers of preterm infants from six tertiary hospitals in Shandong Province was conducted. Mothers were evaluated on the day of discharge (using the Baseline characteristics and Readiness for Hospital Discharge Scale) and three weeks post-discharge (utilizing the Parenting Sense of Competence Scale-Efficacy subscale and Post-Discharge Coping Difficulty Scale). Structural equation modeling was employed to analyze the mediating effect. The results of this study revealed that readiness for hospital discharge significantly decreased post-discharge coping difficulty (β = − 0.533, P < 0.001), and parenting self-efficacy also significantly reduced post-discharge coping difficulty (β = − 0.419, P < 0.001). Furthermore, parenting self-efficacy partially mediated the relationship between readiness for hospital discharge and post-discharge coping difficulty, accounting for 25.35% of the total effect. Mothers reported a moderate level of post-discharge coping difficulty. In assisting mothers of premature infants to alleviate post-discharge coping difficulty, nurses could implement strategies focused on enhancing readiness for hospital discharge and parenting self-efficacy.

Exposure to heat wave risks across time and places: Seasonal variations and predictors of feelings of threat across heat wave geographical susceptibility locations.

Vulnerability to heat waves and their negative effects on health vary not only due to individual factors but also due to situational factors, such as time and geography. Hence, we explored seasonal variations and predictors of heat wave feelings of threat across different heat wave geographical susceptibility locations in Portugal. A total of 238 Portuguese residents responded to a web-based longitudinal survey: before the summer, during a heat wave in the summer, during the summer, and after the summer. Geographical location was used as an indicator of risk exposure, operationalized as heat wave occurrence susceptibility (low, moderate, high). Heat wave demands and resources perceptions were assessed to compute an indicator of heat wave feelings of threat. During the heat wave, feelings of threat were higher among participants in high-susceptibility locations, with demands outweighing resources perceptions, suggesting greater distress and coping difficulty. Regression analysis suggested that older participants and female participants living in moderate-high-susceptibility locations had greater difficulty in recovering. Heat wave risk perception and positive affect about heat were identified as the most consistent predictors of heat wave feelings of threat, with risk perception increasing and positive affect decreasing such feelings. Participants with (individual and geographical) vulnerability profiles, who had greater difficulty in coping and recovering from heat waves, could benefit from resource-building/enhancing interventions. In a climatic crisis context, monitoring psychological responses to heat waves (e.g., threat) may enable anticipated action to build resilience before, rather than after, the effects become damaging to physical and psychological health.

Readiness for hospital discharge and its association with post-discharge outcomes among oesophageal cancer patients after oesophagectomy: A prospective observational study.

To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post-discharge outcomes (post-discharge coping difficulty and unplanned readmission). Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. Prospective observational study. The STROBE statement was followed. In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease-related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post-discharge outcomes were investigated on the 21st day (post-discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self-care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post-discharge coping difficulty (r = -0.729, p < 0.01) and unplanned readmission (t = -2.721, p < 0.01). Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post-discharge outcomes. Healthcare professionals should improve the discharge readiness by constructing high-quality discharge teaching, cultivating patients' self-care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post-discharge outcomes among patients with oesophageal cancer. Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited.

State Perceived Stress Is Concurrently, but Not Prospectively, Associated With State Impulsivity in Youths

Stress is considered a transdiagnostic mechanism underlying psychopathology. Research has suggested that when people experience more stress, they also act more impulsively. Most prior work has focused on between-persons associations or tested broad conceptualizations of impulsivity. We tested associations of momentary reports of perceived stress and appraisal of coping difficulty with three dimensions of impulsivity (urgency, planning, and persistence). High school and college students ( N = 146) self-reported momentary perceived stress, coping appraisals, affect, urgency, planning, and persistence three times per day for 10 days. Higher perceived stress was concurrently associated with higher urgency and lower persistence, even after controlling for negative affect. Higher coping appraisals were concurrently associated with higher planning and persistence. No prospective effects were observed. Perceived stress may relate to a time-limited decreased ability to regulate responses to negative affect and persist, whereas coping appraisals may be associated with changes in multiple types of self-regulation.

Reliability and validity of the Chinese post-discharge coping difficulty scale-parent form in parents of premature infants: a multicenter cross-sectional study.

The measurement of the coping difficulties of parents of premature infants after discharge provides objective data for nurses to prepare infants for discharge. However, no Chinese scale has been developed to measure parents' coping difficulties after their premature infants are discharged. To translate the parent version of the Post-Discharge Coping Difficulty Scale (Ped-PDCDS) from English to Chinese and test the reliability and validity of the Chinese version in parents of premature infants. A multicenter cross-sectional study of 356 parents of premature infants was conducted. The scale was symmetrically translated. Validity was evaluated in terms of content, construct, discriminant, and convergent validities. Reliability was assessed in terms of internal consistency, split-half reliability, and test-retest reliability. The Chinese Ped-PDCDS finally contained 11 items. Exploratory and confirmatory factor analyses results showed that the Chinese Ped-PDCDS had three dimensions, and the convergent and discriminant validities of the scale was satisfactory. The overall reliability, split-half reliability, and test-retest reliability of the scale was 0.85, 0.92, and 0.84, respectively. The Chinese Ped-PDCDS has adequate psychometric properties, and is an easy and appropriate instrument for measuring parents' difficulty in coping with premature infants.

Early Follow-up of Parents by a Specialized Cleft Nurse After the Birth of an Infant with Cleft lip and/or Palate.

To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. The cleft lip and palate team at a University hospital. 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P = .012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P = .112 and the mothers benefitted less from cleft-related activity on the internet (P = .013). The intervention group reported higher mean score for satisfaction with total cleft care (P = .001). There were no significant group differences regarding mean total score for discharge teaching (P = .315) and coping difficulties (P = .919). Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up.

The post-discharge coping difficulty of puerperal women in a middle and low-income tourist city during the COVID-19 pandemic

BackgroundSince the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19.MethodsGeneral information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression.ResultsThe total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P < 0.001). Primipara, family income, health literacy and social support were the main factors influencing maternal coping difficulties after discharge.ConclusionDuring the COVID-19 pandemic, puerperal women in a low- and middle-income city had moderate coping difficulties after discharge and were affected by many factors. To meet the different needs of parturients and improve their psychological coping ability, medical staff should perform adequate assessment of social resources relevant to parturients and their families when they are discharged, so they can smoothly adapt to the role of mothers.

Video-based e-learning program for schoolteachers to support children of parents with mental illness: a cluster randomized trial

BackgroundSome children of parents with mental illness need support. This study aimed to develop and test the effectiveness of an e-learning program for training elementary schoolteachers to support children of parents with mental illness.MethodsThe program, which included a 30-min video-based e-learning program, aimed to help schoolteachers gain basic knowledge about mental illness and children of parents with mental illness, recognize children in need of support, and gain confidence in supporting them. A school-based cluster randomized controlled trial was conducted, and the schools were randomly divided into intervention and control groups. The teachers at these schools signed up for the program and participated individually. The outcome measures for the schoolteachers were evaluated at three time points: baseline (T1), post (T2), and one month later (T3). Along with the Sense of Coping Difficulty subscale (primary outcome measure), the following self-developed outcome measures were used: actual behaviors and attitude toward supporting children, knowledge, and self-assessment of program goals achievement. The Sense of Coping Difficulty subscale results at T3 were compared between the groups. Effectiveness over time was assessed for all the outcome measures. The interaction between baseline and intervention effects on the Sense of Coping Difficulty subscale was analyzed. As a part of the process evaluation, open-ended text responses were analyzed qualitatively.ResultsBaseline responses were collected from 87 participants in the intervention group and 84 in the control group. The total score of the Sense of Coping Difficulty subscale at T3 was significantly lower in the intervention group than in the control group (p = 0.007). Over time, a significant effect was observed on the Sense of Coping Difficulty subscale, actual behavior, knowledge of onset timing and probability of onset, and achievement of all program goals. Exploratory analysis was particularly effective for those who encountered a high level of difficulty in supporting children. The participants’ text responses indicated that they planned to look carefully at children's backgrounds and stay close to them in the future.ConclusionsThe program was effective for schoolteachers in supporting children of parents with mental illness.Trial registrationUMIN000045483; 14/09/2021.

Psychological factors associated with bruxism in a sample of university students from the Colombian Caribbean

IntroductionWithin the theories that explain tooth grinding are dental factors, skeletal malocclusions, occlusal anomalies and defective reconstructions, however, there would be psychological factors that explain this phenomenon.ObjectivesThe aim of the study is to evaluate anxiety, depression and coping responses in university students who self-report clenching or grinding teeth.MethodsDesign: Non-experimental, cross-sectional, and quantitative.Sample: University students (n=25) aged between 18-25 years (mean: 25.3; SD: 2.39), purposive sampling. Participants completed a self-reported questionnaire reporting teeth clenching/grinding habits.Instruments: Standardized instruments were used, such as the State Trait Anxiety Inventory (STAI), Beck’s Depression Inventory (BDI) and Coping Strategies Scale Modified (CSS-M).Procedure: First, the study was disclosed, the participants were informed and signed informed consent. They were asked to complete an instrument on teeth grinding/clenching habits and if it was fulfilled, it was included in the study and the psychological evaluation instruments were administered.Data analysis: An analysis was made using descriptive statistics.ResultsThe STAI results showed a high Anxiety-State in all the participants and the Anxiety-Trait had a prevalence of 92.3%. Regarding the levels of depression, it was evidenced that 7.7% presented moderate depression and 31.6% showed mild symptoms.The most used coping strategies were problem solving (87.2%), positive reappraisal (74.4%) and religious support (71.8%), while the least used were seeking professional help (92.3%), waiting (76.9%), aggressive reaction (74.4%) and expression of coping difficulty (71.8%).ConclusionsUniversity students must cope with an academic load that exceeds their capacity to face academic challenges (Wikes et al., 2019). This demand causes significant discomfort that increases emotions with a high negative charge and favors the appearance or intensification of mental health problems, such as chronic stress, anxiety, depression, nervousness and behavioral disorders.Disclosure of InterestNone Declared

A Structured Discharge Education Intervention for Parents of Newly Diagnosed Pediatric Oncology Patients.

Background: Parents of children newly diagnosed with cancer require specialized knowledge and skills in order to safely care for their children at home. The Children's Oncology Group (COG) developed expert consensus recommendations to guide new diagnosis education; however, these recommendations have not been empirically tested. Methods: We used a sequential two-cohort study design to test a nurse-led Structured Discharge Teaching Intervention (SDTI) that operationalizes the COG expert recommendations in the setting of a tertiary children's hospital. Outcomes included parent Readiness for Hospital Discharge Scale (RHDS); Quality of Discharge Teaching Scale (QDTS); Post-Discharge Coping Difficulty (PDCD); Nurse Satisfaction; and post-discharge unplanned healthcare utilization. Results: The process for discharge education changed significantly before and after implementation of the SDTI, with significantly fewer instances of one-day discharge teaching, and higher involvement of staff nurses in teaching. Overall, parental RHDS, QDTS, and PDCD scores were similar in the unintervened and intervened cohorts. Almost 60% of patients had unplanned healthcare encounters during the first 30 days following their initial hospital discharge. Overall nurse satisfaction with the quality and process of discharge education significantly increased post-intervention. Discussion: Although the structure for and process of delivering discharge education changed significantly with implementation of the SDTI, parent RHDS and QDTS scores remained uniformly high and PDCD scores and non-preventable unplanned healthcare utilization remained similar, while nurse satisfaction with the quality and process of discharge education significantly improved, suggesting that further testing of the SDTI across diverse pediatric oncology settings is warranted.

Parental caregivers' perception of their transition from hospital to home in children with cerebral palsy who have undergone orthopedic surgery

PurposeEvaluate parental perception of the quality of discharge teaching, readiness for discharge, and the impact of these on post discharge coping difficulty and resource utilization in children with cerebral palsy (CP) following surgery. Design and methodsProspective cohort study conducted from September 2017–March 2021 at a pediatric academic medical center. Demographics were collected pre-operatively. Parents completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) within four hours of discharge. Four weeks post-discharge, parents completed the Post-discharge Coping Difficulty Scale (PDCDS). Utilization of healthcare resources were extracted from the electronic health record for 90 days post-operatively. Associations among demographics, RHDS, QDTS, PDCDS and resource utilization were assessed using general linear models; PDCDS's open-ended questions were analyzed using directed content analysis. Results114 parental caregivers participated. Post discharge coping was significantly associated with additional resource utilization: length of stay (p = 0.046), readmissions (p = 0.001), emergency department visits (p = 0.001), clinic calls (p = 0.001) and unplanned clinic visits (p = 0.006). PDCDS was negatively correlated with the QDTS Quality of Teaching Delivered subscale (r = −0.32; p = 0.004) and three of five RHDS subscales: 1) Child's Personal Status (r = −0.24; p = 0.02); 2) Knowledge (r = −0.30; p = 0.005); and 3) Coping Ability (r = −0.39; p < 0.001). Four themes explicated parental coping difficulties. ConclusionParents experiencing coping difficulties were more likely to have difficulty managing their child's care needs at home and required additional health care resources. Practice implicationsRecognizing that parents' readiness for discharge may not reflect their coping abilities post-discharge requiring nurses to coordinate pre- and post-discharge education and support services.

A randomized controlled study of an e-learning program (YURAIKU-PRO) for public health nurses to support parents with severe and persistent mental illness and their family members

BackgroundSupporting parents with severe and persistent mental illness (SPMI) requires knowledge, skills, and a positive attitude toward parenthood. We developed a Japanese e-learning program for public health nurses (PHNs) to enable them to support parents with SPMI and their family members. This study aimed to evaluate the effectiveness of the program in improving the knowledge, skills, attitudes, and self-efficacy of PHNs in supporting them.MethodsA three-hour video-based e-learning program was developed. A randomized controlled trial was conducted with 176 PHNs responsible for maternal and child health in Japan. The outcome measures included the Sense of Coping Difficulty/Possibility Scale, skills to support people with SPMI, and achievement of program goals. Outcome data were collected at three time points during the study: baseline (T1), post-intervention (T2), and one month after T2 (T3) using self-administered electronic questionnaires. Outcome measures were assessed by comparing the two groups at the endpoint (T3) using t-tests and ANOVA. Effectiveness over time was assessed using a mixed model for repeated measures, with group and time interactions as fixed effects.ResultsThe study participants were randomly allocated to two groups:89 in the intervention group, and 87 in the control group. The total score and the scores in the two subscales of the Sense of Coping Difficulty/Possibility Scale in the intervention group at T3 were significantly higher than those in the control group, as shown by the t-test and ANOVA (all p<0.001). The Sense of Coping Difficulty subscale had a large effect size (Cohen’s d=1.27). The analysis of the results of a mixed model for repeated measures showed that the group and time interactions on all outcome measures were not significantly different at T1 but were significantly different at T2 and T3.ConclusionsThe program was effective one month after its completion, particularly in reducing PHNs’ difficulties in supporting parents with SPMI.Trial registrationUMIN000045765, November 1, 2021.

Postdischarge coping difficulties and influencing factors ofpregnant women with gestational diabetes mellitus: Across-sectional study.

Aims and objectivesTo identify coping difficulties after discharge and influencing factors of pregnant women with gestational diabetes mellitus.DesignA cross‐sectional descriptive survey was conducted with gestational diabetes mellitus women from four tertiary hospitals in the Shandong Peninsula in China.MethodsThe study consists of 252 gestational diabetes mellitus women. Survey measures included demographic information, quality of discharge teaching scale, readiness for hospital discharge scale and postdischarge coping difficulty scale. Multiple linear regression analysis was used to explore the factors of coping difficulties after discharge.ResultsThe situation of coping difficulties in pregnant women with gestational diabetes mellitus after discharge is not optimistic. Age, education level, type of birth, parity, quality of discharge teaching and discharge readiness are six factors that significantly influence postdischarge coping difficulties.

Relación entre la ansiedad y estilos de afrontamientos ante los exámenes en estudiantes de psicología

Anxiety as a psychological phenomenon affects different scenarios of life generating alterations in their performance. Its identification and how to cope with it is of importance in the educational sector in particular, as it is manifested before the presentation of exams and how students cope with it, so we sought to identify the levels of anxiety and coping styles of psychology students before exams at a university in Colombia. The COPING coping strategies scale and the AMAS-C scale for anxiety were applied. The methodology is quantitative, with a cross-sectional descriptive level. A non-probabilistic sampling by conglomerate of psychology students from II to X semester 2020-2 was carried out, for a sample of 133 selected students. The results show that the levels of anxiety before exams were 33% clinically significant anxiety, 33% mild anxiety, 22% total anxiety and 22% presented levels of clinically significant extreme anxiety. With respect to coping styles, 100% of the sample used the expression of coping difficulty (EAD). As a conclusion it is evident that the realization of an activity such as exams tends to generate an emotional response in all students, likewise regardless of the degree of anxiety that may be presented in general the main response of coping style, will be to express the difficulty to others as a means of escape.

Transition From Hospital to Home Following Hematopoietic Stem Cell Transplantation: A Feasibility Study for “Rooming in”

Background: The experience of hematopoietic stem cell transplant (HSCT) on both the patients and their caregivers is complex and challenging during hospitalization and post discharge. Complex patient populations require heightened attention on discharge practices to ensure that they are prepared for home regimens. "Rooming in" is a standardized intervention implemented prior to discharge that allows patients and caregivers to assume post discharge care with the support of staff. Other complex patient populations have reported positive outcomes related to "rooming in." Aims: The purpose of this study was to assess the feasibility of a standardized "rooming in" intervention for discharge of pediatric HSCT patients. An additional aim was to describe the quality of discharge teaching, readiness for hospital discharge, and postdischarge coping difficulty in a cohort of HSCT patients using validated questionnaires. Method: Data were collected via medical chart review. A prospective cohort completed validated study questionnaires at discharge and 30 days postdischarge. Results: All caregivers of post-HSCT patients were able to complete the "rooming in" intervention. There was no statistically significant difference for length of stay between the retrospective and prospective cohorts. Caregivers enrolled on the study rated the Quality of Discharge Teaching Scale-Parent Form high (Mdn = 165). Conclusion: We conclude that "rooming in" is a feasible discharge intervention for caregivers of pediatric HSCT patients.

Parent Readiness for Hospital Discharge Scale: Psychometrics and Association With Postdischarge Outcomes.

The purpose of this study is to validate the Readiness for Hospital Discharge Scale (RHDS) for use with parents of hospitalized children. PedRHDS is a structured tool for a discharge readiness assessment before pediatric discharge. Using combined data from four studies with 417 parents, psychometric testing and item reduction proceeded with principal component analysis for factor structure delineation, Cronbach's alpha for reliability estimation, and regression analysis for predictive validity. A 23-item PedRHDS retained the a priori factor structure. Reliability ranged from 0.73 to 0.85 for the 23-item and 10- and 8-item short scales. PedRHDS (all forms) was associated with postdischarge coping difficulty (explaining 12%-16% of variance) and readmission (odds ratio = 0.71-0.80). The PedRHDS and both short forms (PedRHDS-SF10 and PedRHDS-SF8) are reliable and valid measures of parental discharge readiness that can be used as outcome metrics of hospital care and risk indicators for postdischarge coping difficulty and readmission.

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days.

Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient-reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. A two-sample pre- and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process' impact. Health team members (n=105 [pre], n=95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge-related communication and collaboration. Patients (n=413 [pre], n=191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi-square and t tests were used for unadjusted pre- and postintervention comparisons. Logistic regression of readmissions with a matched pre- and postintervention sample included adjustments for patient characteristics and hospitalization factors. Readmissions decreased from 18% to 12% (p<.001); ED visits decreased from 4.4% to 1.5% (p<.001). Changes in health team communication and collaboration and patients' experience of discharge were minimal. The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts.

Transition from Hospital to Home Following Hematopoietic Stem Cell Transplantation

Topic Significance & Study Purpose/Background/Rationale Transition from hospital to home following hematopoietic stem cell transplantation (HSCT) is a challenging and vulnerable time for the caregiver due to the complexity of care needed in the home and may increase the risk of readmission. Methods, Intervention, & Analysis The “rooming in” intervention consists of 24-48 hours prior to discharge, the caregiver assumes all care requiring coordination of medications, feedings, line care and other needs with the RN. Discharge education is completed prior to initiating rooming in. The objective of this study is to evaluate if the current clinical practice of “rooming in” decreases readmission rates within 30 days post-discharge for HSCT patients. Secondary goals include describing the caregiver's perspective of the transition from hospital to home measured by post-discharge coping, hospital discharge readiness, and the quality of the discharge process. This 2-group, non-concurrent study compared readmission rates between 35 historical controls and 35 prospective patients who received the “rooming-in” intervention prior to discharge. Findings & Interpretation Prospective group patient demographics include ages 9 months to 17 years with an average length of stay of 48 days. 28 patients received allogeneic and 7 received autologous transplants. Retrospective patient demographics include ages from 13 months to 21 years with an average length of stay of 43 days. 27 patients received allogeneic and 8 received autologous transplants. Common themes expressed by the families regarding the transition to home are difficult without support of family, difficulty of juggling patient care with other dependents and work, complexity of medication regimen and compliance, and diet requirements. The number of home medications discharged with are significantly associated with the Post-Discharge Coping Difficulty score. Preparation using the Rooming-In intervention does not make a statistically significant difference in readmission rates between the two cohorts. Discussion & Implications A “rooming in” program provides preparation, oversight, and reassurance by the medical team for caregivers. Rooming in allows the provider to identify deficits that the caregiver may struggle with in the home that may result in unnecessary readmissions or poor compliance.

Social resource assessment: Application of a novel communication tool during hospital discharge

ObjectiveTo evaluate an interactive tool designed to help patients communicate their social resources supportive of home recovery to health care providers. MethodsSeventy medical and surgical inpatients completed the D-CEGRM social resource interview, demographic queries, and discharge readiness surveys (RHDS) at discharge. Two weeks later, patients completed post-discharge coping difficulty surveys (PDCDS). Nurses unassociated with patients’ clinical care reviewed structured clinical notes created from the D-CEGRM and categorized patients as likely to have “inadequate” or “adequate” supportive resources for home self-management. Nurse decision making was tracked using an adjudication process, and post-hoc comparisons in patient characteristics, RHDS, and PDCDS were conducted. ResultsNurses categorized 36 patients (51%) as having inadequate resources. Number and accessibility of supports, presence of negative relationships, and previous struggles meeting health-related needs were important decision-making factors. Post-hoc comparisons revealed significant differences in demographic risk factors and discharge readiness ratings for those with inadequate vs. adequate resources. ConclusionThe D-CEGRM may be an efficient tool for patients to communicate access to social resources, and an effective facilitator of transitional care planning.Practice Implications: The D-CEGRM may provide a useful assessment of patients’ home context and guide for transitional care planning.