Readiness For Discharge Research Articles

The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge

ObjectiveThe study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants.Study designParents in the intervention group received FICare, and parents in the control group received standard care.ResultsThe total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group, and a significant difference was observed. A statistically significant difference was found in terms of discharge weight, the day of first enteral feeding, and first breast milk.ConclusionThe FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant’s weight gain, the status of breastfeeding and the continuation of nutrition.Clinical trial registrationRegistered on ClinicalTrials.gov (Identifiers: NCT04478162 Unique Protocol ID: 16214662/050.01.04/14) on 17/07/2020.

Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study

Study designLongitudinal qualitative study, based on a constructivist grounded theory and transformative approach.ObjectivesThis study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury.SettingAn acute inpatient rehabilitation facility in the Midwest United States.MethodsIn-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization.ResultsParticipants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once.ConclusionsThe experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.

Enhanced recovery after surgery for oncological breast surgery reduces length of stay in a resource limited setting.

Early recovery after surgery (ERAS) protocols in breast surgery optimizes resources and reduces healthcare costs by facilitating early discharges. These protocols are well established in tertiary centres, but not commonly adopted in regional centres. ERAS implementation potentially impacts smaller hospitals significantly, where resources are limited and persistent bed shortages with mounting waitlist pressures exist. Our study evaluates the feasibility of early discharge with the application of our ERAS protocol to mastectomies in a resource-constrained and rural setting. Breast cancer patients who underwent mastectomies with or without reconstruction between January 2017 and July 2023 were retrospectively reviewed. From January 2022, we implemented a standardized ERAS protocol for patients undergoing mastectomy. This incorporated a combination of pre-, intra- and post-operative elements to enhance patient readiness for discharge. Our study compared these patients (post-ERAS group) with the outcomes of mastectomies performed prior to January 2022 (pre-ERAS group). 104 patients were identified. In the post-ERAS group, 74.4% were discharged within 24 h compared to 23.1% in the pre-ERAS group. Length of stay was reduced from 2.26 to 1.42 days. There were no differences in unplanned clinician reviews or early representation to the emergency department between the two groups. Reducing the length of stay without increased complications can be achieved in a resource-limited environment with our protocolized ERAS principals. Our protocol has been instrumental in allowing safe discharges within 24 h. Other regional centres may benefit in adopting strategies implemented by us for their own ERAS protocols in breast cancer surgery.

Effect of Orem’s self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of Orem’s self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. Methods92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem’s self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. ResultsThe intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. ConclusionsThe designed discharge readiness program based on Orem’s self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. Trial registrationThe trial number ChiCTR2200056302 registered on ClinicalTrials.gov.

Measuring the continuing care needs of inpatients in rural China

BackgroundInternational experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed.ObjectivesTo measure and assess the continuing care needs of discharged patients and its influencing factors in rural China.MethodsData were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care.ResultsThe analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients’ age group, mode of admission, occupation and major diagnostic categories (P < 0.05).ConclusionsDeveloping continuing care is an important initiative for bridging the fragmentation of health services, and an appropriate supply system for continuing care, interconnected with inpatient services, should be established in rural areas in China as soon as possible. And provide more appropriate care for patients in need.

Emotional distress, social support, and functional dependence predict readiness for hospital discharge in a prospective sample of cognitively intact cardiac arrest survivors

AimTo inform screening, referral and treatment initiatives, we tested the hypothesis that emotional distress, social support, functional dependence, and cognitive impairment within 72 hours prior to discharge predict readiness for discharge in awake and alert cardiac arrest (CA) survivors. MethodsThis was a secondary analysis of a prospective single-center cohort of CA survivors enrolled between 4/2021 and 9/2022. We quantified emotional distress using the Posttraumatic Stress Disorder Checklist-5 and PROMIS Emotional Distress – Anxiety and Depression Short Forms 4a; perceived social support using the ENRICHD Social Support Inventory; functional dependence using the modified Rankin Scale; and cognitive impairment using the Telephone Interview for Cognitive Status. Our primary outcome was readiness for discharge, measured using the Readiness for Hospital Discharge Scale. We used multivariable linear regression to test the independent association of each survivorship factor and readiness for discharge. ResultsWe included 110 patients (64% male, 88% white, mean age 59 [standard deviation ± 13.1 years]). Emotional distress, functional dependence, and social support were independently associated with readiness for discharge (adjusted β’s [absolute value]: 0.25–0.30, all p < 0.05). ConclusionsHospital systems should consider implementing routine in-hospital screening for emotional distress, social support, and functional dependence for CA survivors who are awake, alert and approaching hospital discharge, and prioritize brief in hospital treatment or post-discharge referrals.

Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations.

Children using home invasive mechanical ventilation (HIMV), a valuable therapeutic option for chronic respiratory failure, constitute a growing population. Transitioning children using HIMV from hospital to home care is a complex process that requires a multidisciplinary approach involving healthcare professionals, caregivers, and community resources. Medical stability, caregiver competence, and home environment suitability are essential factors in determining discharge readiness. Caregiver education and training play a pivotal role in ensuring safe and effective home care. Simulation training and staged education progression are effective strategies for equipping caregivers with necessary skills. Resource limitations, inadequate home nursing support, and disparities in available community resources are common obstacles to successful HIMV discharge. International perspectives shed light on diverse healthcare systems and challenges faced by caregivers worldwide. While standardizing guidelines for HIMV discharge may be complex, collaboration among healthcare providers and the development of evidence-based regional guidelines can improve outcomes for children using HIMV and their caregivers. This review seeks to synthesize literature, provide expert guidance based on experience, and highlight components to safely discharge children using HIMV. It further assesses disparities and divergences within regional and international healthcare systems while addressing relevant ethical considerations.

Factors influencing discharge readiness among patients with mild-to-moderate ischemic stroke: a cross-sectional study

Abstract Objective To describe discharge readiness and determine whether self-efficacy, social support, and the quality of discharge teaching can predict discharge readiness among patients with mild-to-moderate ischemic stroke. Methods A total of 120 patients with mild-to-moderate ischemic stroke were recruited using simple random sampling. Five instruments, namely, the Demographic Data Questionnaire, the Chinese version of the Readiness for Hospital Discharge Scale (RHDS_C), the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6), the Perceived Social Support Scale (PSSS), and the Quality of Discharge Teaching Scale (QDTS), were used for data collection. Descriptive statistics and standard multiple linear regression were used for data analysis. Results The mean score of discharge readiness among patients with mild-to-moderate ischemic stroke was at a moderate level (M = 7.6, SD = 0.92), and 75.8% of the participants felt ready for discharge. Standard multiple linear regression revealed that self-efficacy (β = 0.62, P &lt; 0.001) and the quality of discharge teaching (β = 0.28, P &lt; 0.001) were the influencing factors. However, social support could not predict discharge readiness significantly. All the factors combined explained 64.9% of the variance in discharge readiness. Conclusions Intervention programs aimed at improving self-efficacy and the quality of discharge teaching may be helpful in promoting discharge readiness in patients with mild-to-moderate ischemic stroke, especially in coping ability.

COMPARISON OF TIMELY INITIATION OF BREASTFEEDING AND DISCHARGE TIMES OF MOTHERS WITH ETHNIC DIFFERENCES: NORTH MACEDONIA STUDY

The quality of maternity and newborn care and training in the hospitals in North Macedonia is still inadequate today. This study aimed to examine their readiness for discharge and the first breastfeeding time according to ethnic groups in mothers who were postnatal in Tetovo State Hospital North Macedonia. This cross-sectional study was conducted with 202 Macedonian, Albanian, Turkish, Bosnian, and Romanian mothers who were hospitalized in the maternity service of Tetovo State Hospital in North Macedonia. Data were collected before discharge with a survey form and face-to-face interviews. The mothers reported that the first postpartum breastfeeding started after an average of 22.0±20.6 hours. Macedonian mothers reported that they received more training on shower and hygiene (p

Readiness to discharge patients after radical prostatectomy with the assistance of the da Vinci robot

Abstract Aim. The study aimed to assess the readiness for discharge of patients after da Vinci robot-assisted radical prostatectomy. Material and methods. The study included 100 patients on the day of discharge, treated in one of Warsaw’s hospitals at the turn of 2022 and 2023. The study was conducted by means of a diagnostic survey, the tool was the C-HOBIC questionnaire. The SPSS programme was used in the statistical analysis. A statistical signifi cance of p&lt;0.05 was assumed. Results. Patients demonstrated good readiness for discharge, especially in terms of knowledge about taking medications. They showed the lowest readiness when it came to observing disturbing health-related symptoms. Education level had an impact on patients’ ability to take medications. Conclusions. Patients show good readiness to leave the hospital. Their knowledge of how to take medications is particularly good, although being able to notice symptoms or changes in health requires a little more attention. Pre-discharge education is a key element in preparing patients for self-care at home.

Quality of Recovery After Unplanned and Planned Cesarean Deliveries: A Prospective Observational Study Using the Obstetric Quality of Recovery-10 Tool.

There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries. We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings. We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients' perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries). As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.

Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey.

To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness. In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited. Cross-sectional study. Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study. Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect. Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness. It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.

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.

Postanesthesia Care Unit and Anesthetic Management Outcomes Among Patients Undergoing Noncardiac Surgery: Differences by Race and Ethnicity

To investigate the association of patient race and ethnicity with postanesthesia care unit (PACU) outcomes in common, noncardiac surgeries requiring general anesthesia. Single tertiary care academic medical center retrospective matched cohort. We matched 1:1 1836 adult patients by race and/or ethnicity undergoing common surgeries. We compared racial and ethnic minority populations (62 American Indian, 250 Asian, 315 Black or African American, 281 Hispanic, and 10 Pacific Islander patients) to 918 non-Hispanic White patients. The primary outcomes were: the use of an appropriate number of postoperative nausea and vomiting (PONV) prophylactics; the incidence of PONV; and the use of a propofol infusion as part of the anesthetic (PROP). Secondary outcomes were: the use of opioid-sparing multimodal analgesia, including the use of regional anesthesia for postoperative pain control; the use of any local anesthetic, including the use of liposomal bupivacaine; the duration until readiness for discharge from the PACU; the time between arrival to PACU and first pain score; and the time between the first PACU pain score of ≥4 and administration of an analgesic. Logistic and linear regression were used for relevant outcomes of interest. Overall, there were no differences in the appropriate number of PONV prophylactics, nor the incidence of PONV between the two groups. There was, however, a decreased use of PROP (OR=0.80; 95% CI: 0.69, 0.94; P=.005), PACU length of stay was 9.56minutes longer (95% CI: 2.62, 16.49; P=.007), and time between arrival to PACU and first pain score was 2.30minutes longer in patients from racial and ethnic minority populations (95% CI: 0.99, 3.61; P=.001). There were no statistically significant differences in the other secondary outcomes. The rate of appropriate number of PONV prophylactic medications as well as the incidence of PONV were similar in patients from racial and ethnic minority populations compared to non-Hispanic White patients. However, there was a lower use of PROP in racial and ethnic minority patients. It is important to have a health equity lens to identify differences in management that may contribute to disparities within each phase of perioperative care.

Current Status and Influencing Factors of Readiness for Hospital Discharge of Lung Cancer Patients Receiving ERAS-Guided Postoperative Management.

This study ascertained current status and influencing factors of readiness for hospital discharge (RHD) of lung cancer (LC) patients with enhanced recovery after surgery (ERAS) concept-guided postoperative management. This study prospectively and consecutively included 217 LC patients who underwent whole-course ERAS concept-guided postoperative management at the Department of Thoracic Surgery of Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University from November 2023 to April 2024. RHD, quality of discharge teaching (QDT), and social support (SS) were evaluated using RHDS, QDTS, and SSRS, followed by correlation analyses of RHD with the other 2 factors. The clinical baseline and pathological data were compared between the high and low RHD groups, and the characteristics showing statistical significance were assigned as independent variables for regression analysis with RHD as the dependent variable. RHD, QDT, and SS were above average among LC patients with ERAS concept-guided postoperative management, and RHD was positively correlated with both QDT and SS. Age, education level, self-care ability, number of admissions, and presence of drainage tubes were independent influence factors for RHD of LC patients with ERAS concept-guided postoperative management. In LC patients with ERAS concept-guided postoperative management, RHD may be improved by increasing QDT and SS and intervened by factors such as age, education level, self-care ability, number of admissions, and presence of drainage tubes.

Health Literacy Needs of Acute Pancreatitis Patients During the Diagnosis and Treatment Process Under the Lens of the Timing It Right Theory: A Qualitative Study.

The incidence and recurrence rate of acute pancreatitis (AP) continues to increase worldwide. The risk of AP attack and recurrence is closely related to the patient's health literacy. Previous studies have shown that AP patients had low levels of health literacy. Understanding patients' experience in AP's diagnosis and treatment process and their health literacy needs might significantly improve their health status. This study aims to understand the experience of acute pancreatitis (AP) patients in the diagnostic and treatment process and explore their health literacy needs at various phases of this process. This study utilized a qualitative approach based on Timing It Right theory. A purposive sampling strategy was employed to select 31 participants diagnosed with AP at various phases of the diagnosis and treatment process. These patients were selected from the Pancreatitis Treatment Centers of two tertiary hospitals in Eastern China. Subsequently, semi-structured in-depth interviews were conducted with the selected participants. The qualitative data was analyzed using the Colaizzi's method. The themes of AP patients' experiences and health literacy needs at various phases of the diagnosis and treatment process were presented as follows. 1. Diagnosis phase: inability to obtain disease information, psychological support seeking, and change unhealthy lifestyle; 2. Hospitalization phase: disease treatment information needs and medical professionals' healthcare. 3. Discharge Preparation phase: fear of recurrence, individualized healthy lifestyle instruction. 4. Home Recovery phase: self-management, continuous healthcare needs, and family support. AP patients' HL needs and health-related problems vary during the diagnosis and treatment process. Medical professionals should comprehend AP patients' changing needs and individual differences, provide continuous healthcare, and involve families in patient management. These factors support patients' long-term self-management and preserve their overall health.

STUDY OF RATE, CAUSE AND PATTERN OF HOSPITAL READMISSIONS IN EMERGENCY MEDICINE OF A TERTIARY CARE HOSPITAL IN NORTH INDIA

Introduction: Hospital readmission rates serve as crucial indicators of healthcare quality, with significant implications for patient outcomes and financial costs. This study aims to investigate the rates, causes, and patterns of hospital readmissions in the emergency medicine department of a tertiary care hospital in North India. Methodology: A prospective study spanning one year was conducted, involving 4116 patients admitted through emergency medicine. The study analyzed readmission rates at different intervals (7 days, 30 days, 90 days, and 1 year) and considered demographic factors, primary diagnoses, and comorbidities. Data were collected through systematic random sampling and reinforced with semi-structured interviews and administrative records. Results &amp; Observations: The study revealed varying readmission rates across different time intervals and diagnoses. Gastrointestinal disorders and respiratory diseases consistently exhibited elevated readmission rates. Age, gender, and Charlson Comorbidity Index were identified as significant factors influencing readmission patterns. Patients aged 50-59 years and males demonstrated higher readmission rates. The severity of comorbidities, as measuredbytheCharlson Comorbidity Index, was positivelycorrelated with increased readmission rates. Discussion: The findings underscore the importance of targeted post-discharge care, disease-specific interventions, and tailored strategies for specific demographics. The study emphasizes the need for enhanced monitoring and interventions, especially in the later stages post-discharge. Patient-centric insights highlight the role of discharge readiness and patient perceptions in influencing readmission dynamics. Conclusion: This study provides comprehensive insights into the complex factors influencing hospital readmissions in the emergency medicine setting. It emphasizes the necessity for focused interventions, customized care strategies, and all-encompassing approaches to reduce readmission risks. Healthcare institutions are encouraged to prioritize transitional care, interdisciplinary collaboration, evidence-based interventions, and patient-centered care models to optimize patient outcomes and alleviate the economic burden associated with avoidable readmissions.

Factors associated with family caregiver readiness to care for post-stroke patients after hospital discharge

BackgroundPost-stroke patients often need support from their family caregivers to continue their care after hospital discharge. Family caregiver readiness in caring for stroke patients is needed to improve the patient's quality of life. This study aimed to analyze factors affecting family caregivers' readiness for post-stroke patient care after hospital discharge.MethodsA cross-sectional study of family members of stroke patients admitted to the neurology inpatient unit from February to April 2023, and they were selected through purposive sampling. The general demographic questionnaire, the stroke knowledge questionnaire, and the Family Readiness for Hospital Discharge Scale (FAM-RHDS) were used to gather the data. Data analysis was performed with IBM SPSS 26 software. Data were examined through the descriptive, Pearson correlation, and multiple linear regression tests.ResultsFifty-nine respondents completed the questionnaires. Factors that were significantly related to family readiness to care for stroke patients were age (p = 0.000), gender (p = 0.000), income (p = 0.000), occupation (p = 0.000), marital status (p = 0.000), and knowledge (p = 0.000). Education level was the one that didn’t correlate with family readiness (p = 0.452). Gender is the most dominant factor affecting the readiness of family caregivers to care for stroke patients (coefficient B = 10.847).ConclusionMale family caregivers should be given special attention to improve their readiness to care for post-stroke patients. Assessment of family caregivers’ readiness for discharge should be part of discharge planning and those who are unprepared may be provided with additional interventions prior to discharge.

'When age is not a barrier': an explorative study of nonagenarian patients' experiences of undergoing percutaneous coronary intervention.

The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital.

Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions.

Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission. Examine the effect of nurse assessments of discharge readiness on 30-day readmissions. Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals. A total of 188,806 Medicare surgical patients with MCCs. Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count. The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs. Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.