Coping Difficulty Research Articles

Parental Adverse Childhood Experiences and Resilience on Coping After Discharge.

Adults with a history of adverse childhood experiences (ACEs) (eg, abuse) have suboptimal health outcomes. Resilience may blunt this effect. The effect of parental ACEs (and resilience) on coping with challenges involving their children (eg, hospitalization) is unclear. We sought to quantify ACE and resilience scores for parents of hospitalized children and evaluate their associations to parental coping after discharge. We conducted a prospective cohort study at a children's hospital (August 2015-May 2016). Eligible participants were English-speaking parents of children hospitalized on the Hospital Medicine or Complex Services team. The ACE questionnaire measured the responding parent's past adversity (ACE range: 0-10; ≥4 ACEs = high adversity). The Brief Resilience Scale (BRS) was used to measure their resilience (range: 1-5; higher is better). The primary outcome was measured by using the Post-Discharge Coping Difficulty Scale via a phone call 14 days post-discharge (range: 0-100; higher is worse). Associations were assessed by using multivariable linear regression, adjusting for parent- and patient-level covariates. A total of 671 (81% of eligible parents) responded. Respondents were primarily women (90%), employed (66%), and had at least a high school degree (65%); 60% of children were white, 54% were publicly insured. Sixty-four percent of parents reported ≥1 ACE; 19% had ≥4 ACEs. The mean Brief Resilience Scale score for parents was 3.95. In adjusted analyses, higher ACEs and lower resilience were significantly associated with more difficulty coping after discharge. More parental adversity and less resilience are associated with parental coping difficulties after discharge, representing potentially important levers for transition-focused interventions.

Using Technology to Enhance Discharge Teaching and Improve Coping for Patients After Stroke.

A diagnosis of stroke is a life-changing event. Effective discharge teaching after a stroke is crucial for recovery, but the overload of information can be overwhelming for patients and caregivers. The purpose of this study was to examine differences in discharge readiness and postdischarge coping in patients admitted for stroke after the use of individualized postdischarge information/education provided via a technology package (including patient online portal access, e-mail/secure messaging) compared with current standard discharge teaching methods (verbal/written instructions). This study used a descriptive comparative design to evaluate the difference between the nonintervention group A and the intervention group B. Patients in group B received additional discharge information via secured e-mail messaging at postdischarge days 2, 6, and 10. Two validated tools, Readiness for Hospital Discharge Form and Post-Discharge Coping Difficulty Scale, were used. One hundred patients were recruited for the study, but the final number of complete data sets collected was 86-42 in group A and 44 in group B. There was no statistically significant difference between the groups in discharge readiness. There was a significant difference in coping scores between the 2 groups, with the technology group exhibiting higher coping. New technology affords new options to improve discharge readiness and contribute to positive patient coping after stroke. The researchers hope that this study will contribute to the growing body of evidence showing success using aspects of technology to enhance discharge teaching and follow-up after discharge.

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

PurposeThis 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/methodsIn 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 3weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). ResultsParent-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%. ConclusionThere 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 ImplicationsEfforts 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.

How does the common core to the harm experienced by affected family members vary by relationship, social and cultural factors?

This paper takes an international perspective on the harm to close family members caused by addiction. It draws on data collected by the Addiction and the Family International Network (AFINet), England, and their colleagues in other countries. It includes qualitative data based on semi-structured interviews in Mexico, England, Australia (an Indigenous sample), Nigeria, and India; quantitative data based on the use of a standard set of questionnaires specifically designed or chosen for use with family members affected by addiction problems collected in Mexico, England, Italy, Brazil and the USA. The results are interpreted to suggest that, although there is a common core to the harm experienced by all affected family members (AFMs), the family harm is variable, dependent in important ways on relationship, social and cultural factors. Specifically, it is hypothesised that AFMs experience greater coping difficulty and higher levels of strain under conditions of: greater accumulated burden; a family position of structural subordination and dependence; and lack of good quality social support.

Quality of Transition From Hospital to Home: The Influence of Nurse- and Patient-Reported Readiness.

Identifying those at risk of poor outcomes after hospital discharge is a central focus of health care systems. Our purpose was to better understand whether and how patient- and nurse-assessed readiness for discharge (Pt- and RN-RHDS) is related to patient experiences after discharge. We conducted a prospective survey of 70 Veterans and their assigned nurses on the day of, and again with Veterans 2 weeks after, hospital discharge. The predictive model for post-discharge coping difficulty included educational level ( p = .05) and an interaction between Pt-RHDS ratings and Pt-RN RHDS discordance ( p = .01). The predictive model for patient-reported quality of hospital to home transition experience included Pt-RN RHDS discordance and an interaction between Pt-RHDS and the number of people living with the patient ( p = .05). Our findings demonstrate that agreement between Pt- and RN-RHDS may be an important measure in work aiming to improve patient outcomes post-hospitalization.

Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed With Diabetes.

The purpose of this study was to identify factors affecting early and intermediate hospital-to home transition outcomes of older adults with preexisting diabetes mellitus. A mixed-methods design was used. A sample of 96 hospitalized older adults with a prior diagnosis of diabetes were recruited within 4 hours of discharge. Data reflective of general health status, diabetes status, perceived discharge readiness (Readiness for Hospital Discharge Scale), hospitalization, and anticipated postdischarge support were gathered upon enrollment. Transition outcome data including unplanned care encounter occurrences, perceived transition quality (Care Transition Measure-15), and postdischarge difficulty (scale and free responses to the Post-Discharge Coping Difficulty Scale [PDCDS]) were obtained by telephone interview 7 and 30 days after discharge. Three unique, dichotomous variables were created from recurrent subthemes that emerged during content analysis of free-response data and were used in statistical testing. Binary logistic regression was performed to identify predictive factors for an unplanned care encounter within 30 days of discharge. Multimorbidity was prevalent in participants. Difficulties managing medications, blood glucose, and chronic illnesses other than diabetes were common problems. Higher PDCDS scores 7 and 30 days following discharge and difficulty managing a nondiabetes chronic health problem were predictive of an unplanned care encounter within 30 days of discharge. Multimorbidity complicates home recovery of older adults with diabetes. Diabetes adds complexity to hospital-to-home care transitions. Transition difficulties predict higher risk for an unplanned care encounter. More intensive follow-up of older adults with diabetes during the first month following discharge is recommended.

A Randomized Trial of a Bereavement Intervention for Pregnancy Loss

To examine the effects of a secondary bereavement intervention on grieving in women who experienced a miscarriage (pregnancy loss) at 12-20 weeks gestation. Experimental, posttest only, control group design. Obstetric emergency center of a county hospital in a large city. Forty women who experienced complete spontaneous miscarriages in the first or second trimester (8-20 weeks gestation). Participants were randomly assigned to the grief intervention treatment group or usual standard care control group. The Medical Professional Guidelines for Health Care Professionals were used to construct the perinatal grief intervention. The Perinatal Grief Scale (PGS) was completed during a routine follow-up visit 2 weeks postloss. A one-way multiple ANOVA (MANOVA) was used to examine the difference in grieving between the control and experimental groups. Three dependent variables were used: despair, difficulty coping, and active grieving. Analysis revealed a significant difference on the combined dependent variables, F(3, 36) = 22.40, p < .000. When considering the three dependent variables separately, the treatment group displayed significantly lower levels of despair, F(1, 38) = 42.27, p < .001. Active grieving was high in both groups with the treatment group mean higher than the control group. Group means were similar for coping difficulty. A bereavement intervention administered immediately after the miscarriage promotes women's ability to cope with early pregnancy loss.

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

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.

Abstract 358: Patient Satisfaction and Preference Assessment Post Outpatient Electrophysiology Procedures: Same Day versus Next Day Discharge

Objectives: Multiple studies have reported the safety of same day discharge (SDD) post-electrophysiology (EP) procedures, while patient satisfaction associated with this approach has not been well- studied. We sought to evaluate whether SDD would be associated with a comparable patient satisfaction rate compared with next day discharge (NDD) in various EP procedures. Furthermore, we aimed to assess patient preferences regarding discharge timing. Methods: A cohort of patients was identified using our institutional record of all outpatient EP lab procedures from August 2013 to November 2014. From this list, 6 groups were created based on discharge timing “SDD/NDD” and procedure “Ablation (A)/Pacemaker (P)/ICD (I)”. All operators offered SDD and were included. We excluded generator change and lead extraction procedures. Patients who stayed more than one night were also excluded. Post-discharge phone surveys were conducted starting from the most recent procedure until the target number was reached. The research team gathering surveys was blind to patient characteristics. The survey was composed of 24 questions, 10 of which were for Post-Discharge Coping Difficulty Scale (PDCDS). Results: We surveyed 132 patients, 53F/79M, 66 SDD/66 NDD with mean age (SD) of 63 (15). We had 29 patients in each A group, 17 in each I group, and 20 in each P group. Patients’ rating of overall satisfaction and readiness for discharge, as well as, calculated PDCDS outcomes were not significantly different in SDD vs. NDD for all procedures, I+A only, and A only ( p &gt;.05). Patient characteristics and procedural complications between groups did not differ significantly, though different operators did differ in numbers of SDD or NDD procedures. No significant interactions were found between various covariates and study outcomes including age, gender, BMI, number of home medications, operator, and type of procedure. Approximately1/3 of patients (43/132) were given the choice of the two discharge strategies by the operator. The majority of them (93%; 40/43) opted for SDD and rated “the opportunity for this choice” with a mean of 9.1 (1-10 scale, 10 excellent) in comparison to a mean of 6.7 for those who were not given the choice ( p &lt;. 0001). Only 12% (8/66) of SDD patients wished they had the alternative discharge strategy (P &lt; .0001), in comparison to 38% of NDD patients (25/66) ( p &lt;. 07). Overall, 51% (67/132) of all patients preferred SDD if they were to undergo similar procedure in the future. Conclusions: SDD strategy resulted in similar patient satisfaction to NDD strategy across different EP procedures and operators. Patients significantly appreciated the choice of SDD. The SDD group was more willing to repeat their discharge experience. This further supports following SDD strategy, whenever possible, to improve quality of care; in addition to the cost savings and increased efficiency associated with this approach.

Pediatric solid organ transplant recipients: transition to home and chronic illness care.

Pediatric SOT recipients are medically fragile and present with complex care issues requiring high-level management at home. Parents of hospitalized children have reported inadequate preparation for discharge, resulting in problems transitioning from hospital to home and independently self-managing their child's complex care needs. The aim of this study was to investigate factors associated with the transition from hospital to home and chronic illness care for parents of heart, kidney, liver, lung, or multivisceral recipients. Fifty-one parents from five pediatric transplant centers completed questionnaires on the day of hospital discharge and telephone interviews at three wk, three months, and six months following discharge from the hospital. Care coordination (p = 0.02) and quality of discharge teaching (p < 0.01) was significantly associated with parent readiness for discharge. Readiness for hospital discharge was subsequently significantly associated with post-discharge coping difficulty (p = 0.02) at three wk, adherence with medication administration (p = 0.03) at three months, and post-discharge coping difficulty (p = 0.04) and family management (p = 0.02) at six months post-discharge. The results underscore the important aspect of education and care coordination in preparing patients and families to successfully self-manage after hospital discharge. Assessing parental readiness for hospital discharge is another critical component for identifying risk of difficulties in managing post-discharge care.

Difficult Hospital-to-Home Transitions Worsen Outcomes in Elders with Diabetes

This article discusses results from a study demonstrating that the hospital-to-home transition in older adults with diabetes mellitus (DM) is affected by a variety of personal, hospital, and community factors. Recidivism within 30 days of discharge was associated with increased coping difficulty in elders, and common complications included medication management, trouble controlling glucose, and regulating another chronic illness.

Relación entre las estrategias de afrontamiento, ansiedad, depresión y autoestima, en un grupo de adultos con diagnóstico de cáncer

El presente estudio es de tipo descriptivo correlacional, tiene como objetivo identificar la relación existente entre las estrategias deafrontamiento, los niveles de autoestima, ansiedad y depresión en un grupo de 17 pacientes adultos con diagnóstico de cáncer, paralo cual se emplearon la Escala de Autoestima de Rosemberg, la Escala Hospitalaria de Ansiedad y Depresión (had) y la Escala deEstrategias de Coping Modificada (eec-m). Se obtuvo como resultado una correlación significativa entre los niveles de ansiedad y losniveles de autoestima y entre los niveles de ansiedad y las estrategias de afrontamiento de solución de problemas, reevaluación positiva yreacción agresiva. Al igual que una correlación significativa entre los niveles de depresión y las estrategias de afrontamiento de solución deproblemas, negación, reacción agresiva y la expresión de la dificultad de afrontamiento.

Assessing Patient-Reported Outcomes and Preferences for Same-Day Discharge After Percutaneous Coronary Intervention

Same-day discharge after percutaneous coronary intervention (PCI) may be safe for some patients. Few data are available on patient-reported outcomes and preferences for same-day discharge after PCI. Between March 2008 and March 2010, a total of 298 patients undergoing elective PCI via femoral access at 2 medical centers (Mount Sinai Hospital, New York, NY, and Baylor Medical Center, Dallas, TX) were randomized to same-day (n=150) or next-day (n=148) discharge. The primary outcome was high patient coping during the 7 days after discharge defined as scores <20 on the validated postdischarge coping difficulty scale. Safety outcomes, clopidogrel adherence, and patient preferences were secondary outcomes. Before discharge, patients randomized to same-day and next-day discharge were similar with respect to sociodemographic and clinical characteristics. High-coping ability, assessed 7 days after PCI, was present for 79% of patients randomized to same-day discharge and for 77% of patients randomized to next-day discharge. The difference in high coping ability, 2 (95% confidence interval, -7 to 11), did not cross the noninferiority threshold of -12% (P<0.001 that same-day discharge is not noninferior to next-day discharge). At 30 days after PCI, clopidogrel adherence, physician and emergency room visits, and hospitalization were similar in the 2 randomization groups. In addition, 80% and 68% of those randomized to same-day and next-day discharge, respectively, stated they would prefer same-day discharge if they were to have another PCI procedure. Same-day discharge after PCI was associated with patient-reported and clinical outcomes similar to those of next-day discharge and was preferred by most patients.

Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain

The objectives of this study were to examine whether (1) daily pain-related changes in physical functioning differed between happily partnered, unhappily partnered, and unpartnered female chronic pain patients, and (2) affect and pain cognitions mediated the partner status effect on pain-related changes in physical functioning. Two hundred fifty-one women with chronic pain due to osteoarthritis and/or fibromyalgia completed 30 daily electronic diaries assessing pain, affect, pain-related cognitions, and physical functioning. Patients living with a romantic partner also completed a modified version of the Locke-Wallace Marital Adjustment Scale to assess relationship satisfaction. Multilevel modeling revealed that patients in satisfying unions showed more adaptive daily pain-related changes in physical functioning, pain coping difficulty, and catastrophizing compared to those in unsatisfying unions and those who were unpartnered. Both partnered groups also showed more adaptive pain-related changes in positive affect compared to the unpartnered group. The impact of relationship status on pain-related changes in physical functioning was partly mediated by the pain cognitions catastrophizing and coping difficulty. These results indicate that happily partnered pain patients show less pain-related physical disability and more adaptive affective and cognitive responses to daily pain changes than do unhappily partnered and unpartnered patients. Living in a happy union may bolster the capacity of patients to sustain a sense of pain coping efficacy during pain episodes, which in turn, minimizes pain-related physical activity limitations.

How ready are they? Parents of pediatric solid organ transplant recipients and the transition from hospital to home following transplant

Poor discharge transition is evidence of a gap between evidence-based practices and current health care delivery. Pediatric SOT recipients are a vulnerable population at risk of complications during the discharge transition. The aim of this study was to investigate factors associated with the transition care from hospital to home. We studied the transition experience of parents of heart, liver, or kidney recipients to identify opportunities for improvement in discharge and post-discharge care processes and outcomes. Thirty-seven parents from three different pediatric transplant centers completed questionnaires on the day of hospital discharge and three wk following hospital discharge. Care coordination was associated with readiness for hospital discharge. Readiness for hospital discharge was subsequently associated with post-discharge coping difficulty, adherence difficulty with medical follow-up, and family impact. Identifying parents who are not ready to go home provides an opportunity to offer additional support services so parents can effectively manage their child's recovery and continuing care at home.

The components of cognitive vulnerability to generalized anxiety disorder

The components of cognitive vulnerability to generalized anxiety disorder (GAD) were identified. We performed a comparative analysis between the cognitive profile of patients diagnosed with GAD (69 adults) and a control group with no diagnosis (69 adults). They were completed the MINI International Neuropsyquiatric Interview, the Young Schemes Questionnaire -YSQ-, the Core Beliefs Questionnaire for Personality Disorders -CCE-TP-, the Inventory of Automatic Thoughts -IPA-, and the Coping Strategies Questionnaire -EEC-M-. The cognitive profile of GAD comprised patterns of abandonment, mistrust/abuse, uncompromising standards and insufficient self-control/self-discipline. Associated personality disorders were dependent, paranoid, avoidant, schizotypal, borderline and antisocial. Cognitive distortions were filtering or selective abstraction (low scores), and significantly higher scores in polarized thinking, overgeneralization, interpretation of thought, catastrophic vision, fallacy of control, emotional reasoning and fallacy of change. Coping strategies were high aggressive reaction, expression of coping difficulty, denial, and low positive reappraisal.

Predictors and Outcomes of Postpartum Mothers' Perceptions of Readiness for Discharge after Birth

To identify predictors and outcomes of postpartum mothers' perceptions of their readiness for hospital discharge. A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables. Midwestern tertiary perinatal center. One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants. Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data. Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services. Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers' perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses' skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services. A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth.

Coping Difficulties After Hospitalization

Coping difficulties of 113 adults 3 weeks after hospital discharge were identified using the Post-Discharge Coping Difficulty Scale and a brief focused telephone interview (11-item guide). Overall, low difficulty scores were reported (M = 23.9, SD = 18.2, range = 0 to 100). Qualitative data reveal specific coping difficulties in the categories of stressors, specific difficulties, caring for self, managing the condition, family, advice needed, contact with the health care system, and what they wished they knew before discharge. A core theme of biographical reconstruction emerged.

Readiness for Discharge in Parents of Hospitalized Children

Parental preparation for a child's discharge from the hospital sets the stage for successful transitioning to care and recovery at home. In this study of 135 parents of hospitalized children, the quality of discharge teaching, particularly the nurses' skills in "delivery" of parent teaching, was associated with increased parental readiness for discharge, which was associated with less coping difficulty during the first 3 weeks postdischarge. Parental coping difficulty was predictive of greater utilization of posthospitalization health services. These results validate the role of the skilled nurse as a teacher in promoting positive outcomes at discharge and beyond the hospitalization.

Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients' perceptions of their readiness for hospital discharge. A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Midwestern tertiary medical center. 147 adult medical-surgical patients. 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. 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. 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. 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.