Patient Readiness Research Articles

The Extent of Nurses' Discharge Education to the Patient's Preparedness for Self-Management

Background:Nurses are known for providing their patients with comprehensive care; patient education through discharge instructions typically falls short of expectations due to understaffing and work overload. Patient self-management of their health conditions at home demands adequate discharge education. Insufficient discharge education can compromise patients' ability to manage their health conditions at home, causing unplanned hospital readmissions. When the patients feel that they are being cared for through the provision of discharge education, they are likely to comply with the instructions given, which may contribute to the patient's optimal well-being and may prevent hospital readmission. Objective: This study aimed to determine the correlation between nurses' extentofdischargeeducationandpatients'preparednessforself-management.Methods:Adescriptive-correlational research design was used to determine the correlation between nurses' extent of discharge education and patients' preparedness for self-management. One hundred eight (108) respondents were selected through consecutive sampling. They answered the Medication, Exercise, Health Teaching, Outpatient Patient Department Visit, Referral, Diet, and Spirituality (MEHORDS) discharge assessment tool. MEHORDS is a researcher-made questionnaire with 0.756 and 0.789 reliability coefficients for assessing nurses' extent of discharge education and patients' preparedness for self-management, respectively. Results:The study shows that most of the respondents are middle-aged adults (22.22%), male (57%), married (63.89%), high school graduates (69.44%), unemployed (61.11%), with cerebrovascular disease (35.91%), and have experienced at least one hospital readmission (37.96%). The study revealed that respondents received a poor level of discharge education (x=1.49) during their discharge process and had no overall preparedness (x = 1.75) for self-management. Moreover, there is a significant positive correlation between the nurses' discharge education and patients' preparedness for self-management (p=0.001). Conclusion:This study highlighted the importance of providing nurses comprehensive discharge education in promoting patients' self-management. Incorporating the MEHORDS contents may not only assist the nurses in managing their time in the provision of discharge education to patients but also serve as a guide to nurses in delivering a thorough discharge education

Orthodontic patient’s perspectives, attitudes, and readiness toward teleorthodontics

Abstract Aim: To evaluate the perspective, attitude, and readiness of orthodontic patients toward teleorthodontics. Materials and Methods: This prospective study was conducted at an orthodontic specialist clinic, Kulliyyah of Dentistry, Kuantan Pahang, Malaysia, involving all 46 orthodontic patients requiring active orthodontic treatment from February to July 2021. Patients were offered four options of online consultation: telephone call, virtual meeting, WhatsApp messaging, and a combination of all three methods. An online survey was distributed after the online consultations to assess patients’ perspectives, attitudes, and readiness toward teleorthodontics. Descriptive statistics were used to summarize the demographic data. Mann–Whitney U test and Kruskal–Wallis test were used to compare the patient’s perspectives, attitudes, and readiness toward teleorthodontics based on their demographic background. A Spearman’s correlation coefficient looked at the linear relationship between the perspective, attitude, and readiness toward teleorthodontics practice. Results: About 82.4% agreed that teleorthodontics was convenient. About 82% agreed that teleorthodontics should be practiced during the pandemic and 72% agreed that it should be practiced after the pandemic. About 89.1% agreed that teleorthodontics bring benefits during the pandemic, and 74% agreed that teleorthodontics might bring benefits after the pandemic. No significant difference was found between sociodemographic background with the total scores of patients’ perspectives, readiness, and attitude toward teleorthodontics. Conclusions: The majority of the patients showed good perspective, attitude, and readiness toward teleorthodontics. Teleorthodontics on certain clinical procedures can be implemented postpandemic to reduce in-office orthodontic visits.

Improving Hurricane Preparedness Among Galveston County Older Adults: Description of a Successful Community-Based Quality Improvement Model.

Older adults are at high risk of experiencing injury, exacerbations of their chronic conditions, and death when evacuations are ordered because of hurricanes or natural disasters. The Homebound seniors residing in Galveston County are at a particularly high risk of morbidity and mortality during evacuations for hurricanes. This paper described the impact of a quality improvement intervention designed and implemented by nurse practitioners during the 2022 and 2023 hurricane season. The education program aimed at increasing the hurricane preparedness of the home-bound patients. Of these patients, 190 returned pre and post surveys. Interventions showed a 43% increase in patients having an evacuation plan in the event of a hurricane, 633% increase in STEAR registration, 16% increase in patients having access to emergency supplies, and 34% increase in patients having an emergency contact list with up-to-date medication list. All improvements on hurricane preparedness items were significant (p < .0001) except for the need for assistance in case of an evacuation. Our findings suggest a need for continuous hurricane preparedness education in the community to ensure safe evacuation, improve hurricane preparation, and increase the number of seniors who registered with the State of Texas Emergency Assistance Registry.

Development of the Readiness for Hospital Discharge Scale for Patients with Bile Duct Carcinoma Catheterized After Percutaneous Transhepatic Cholangial Drainage: A Validity and Reliability Study.

We develop the Readiness for Hospital Discharge Scale (RHDS) for patients with bile duct carcinoma catheterized after percutaneous transhepatic cholangial drainage (PTCD) and test the reliability and validity of the scale, so as to provide a quantitative tool for evaluating the discharge readiness of patients catheterized after PTCD. The initial scale was developed following literature review, qualitative interviews, expert consultation, and other methods based on Meleis' Theory of Transition. We selected a total of 286 patients with bile duct carcinoma catheterized after PTCD from four tertiary A-grade hospitals in Nantong City. We conducted a cross-sectional survey using the initial scale to test the validity and reliability of the scale. RHDS for patients catheterized post-PTCD consisted of five dimensions, with a cumulative variance contribution rate of 74.6%. The Cronbach's α coefficient of the scale was 0.856, and that of each dimension was between 0.740 and 0.891; the scale-content validity index (S-CVI) was 0.875. RHDS for patients with bile duct carcinoma catheterized after PTCD developed in this study, has good reliability and validity, and can be a useful tool for evaluating the discharge readiness of patients with bile duct carcinoma catheterized after PTCD.

Pengaruh Pengetahuan Discharge Planning Terhadap Kesiapan Pasien Asma Menghadapi Pemulangan Di RSUD Dr. M.Yunus Bengkulu

Background: Asthma is one of the non-communicable diseases and belongs to the group of chronic lung diseases. The patient’s lack of knowledge about asthma which causes asthma to recur, so a patient’s return plan is needed so that the patient really feels healthy and is ready to go home. Methods: The research is a quantitative pre-experiment study with one group pre and post test design. The population in this study were all asthma patients treated at RSUD Dr. M.yunus with total 64 people. The sample is 15 respondents with purposive sampling technique. Data were analyzed using nonparametric analysis Wilcoxon test. Results: before being given discharge planning knowledge of on the readiness of asthma patients facing repatriation there were 73.3% ready to face repatriation and after being given knowledge of discharge planning there has been increase 86.7%. Based on the results of the Wilcoxon test it was obtained that p-value = 0.001 which means there is a significant influence of discharge planning knowledge on the readiness of asthma patients facing repatriation. Keywords : Asthma Patients, Knowledge of Discharge Planning, Repatriation Readiness

FACTORS ASSOCIATED WITH OLDER ADULTS’ READINESS FOR DISCHARGE FROM POST ACUTE CARE TO HOME

Abstract Following acute hospitalization, older adults are often transferred to post-acute care (PAC) for rehabilitation and nursing care. Most PAC admissions are comprised of adults with multimorbidity (&amp;gt;2 chronic diseases). After PAC discharge many patients are rehospitalized within 30 days. The goal of this study was to evaluate factors associated with older adult’s readiness for PAC discharge to home. A prospective one-arm descriptive correlation study was conducted. Older adults (N=19) discharged from PAC to home participated. Subjects were recruited over a 3-month period from a large midwestern facility. Participants completed the Patient Readiness for Hospital Discharge -Short Form (PR RHDS-SF) and Patient Activation Measure (PAM). Medication burden, measured by the medication regimen complexity index (MRCI) calculated from discharge medication record. Participants included 12 females and 5 males, mean age of 73 (SD 8.2)) years. The PT RHDS -SF mean score was 49.3 (SD 16.8). The PAM mean score was 54.7 (SD 7.4). Medication burden was high, mean MRCI was 31.5 (SD 11.6). There was a significant correlation [r (17) .48, p=.04] between total PT RHDS-SF score and patient activation levels. Preparing PAC patients to self-manage their multimorbid conditions may enhance their self-confidence with transition from PAC to home. Evaluating self-management preparedness of older adults prior to PAC discharge is vastly understood. Research is needed to prepare multimorbid older adult patients transitioning from PAC to home focused on perceived readiness and self-management confidence.

Informing and Preparing Patients for Echocardiography

Aim. To examine the awareness and preparedness of patients for echocardiography regarding age, gender, education level, and the type of examination. Methods. A cross-sectional study included patients who came for echocardiography through the outpatient clinic and Clinical Departments of the Clinical Hospital Center Osijek during March and April 2023. A survey questionnaire developed for this research was used as the research instrument on patients’ awareness and preparedness for echocardiography. Results. The study included 106 participants, of which 52 (49%) were males and 54 (51%) were females, with 51% of them having undergone 1 – 3 echocardiographic examinations before. Most participants, 83 (78%), received information verbally. There was no significant difference in the awareness and preparation of participants for echocardiography regarding gender and age. Participants with higher education levels agreed that they knew how the examination was conducted before coming, unlike participants with lower levels of education, and there was a significant statistical difference between the groups (p=0.02). Participants who underwent transesophageal echocardiography stated that they were better informed and prepared compared to those who underwent transthoracic echocardiography (p=0.01). Conclusion. The results of the conducted research indicate that participants are well informed and prepared for echocardiographic examinations, with no significant differences based on gender and age. Participants who underwent transesophageal ultrasound of the heart considered themselves better informed and prepared compared to those who underwent transthoracic echocardiography.

Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT)

PurposeTo ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients’ discharge readiness evaluation. DesignThis is a methodological study. MethodsThe development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study. FindingsThe final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99. ConclusionsThe Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.

Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients.

Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. All Medicare patients in the study's intervention arm (n=14,684). Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.

Mobility Checklist for Patients With Advanced Heart Failure and a Femoral Intra-aortic Balloon Pump

Background and Purpose: Literature about early mobilization of patients with femoral intra-aortic balloon pumps (IABPs) is emerging. The purpose of our study is to describe the development and implementation of a mobility checklist for patients with advanced heart failure (HF) who had a femoral IABP and assess its safety and feasibility. Case Description: A description of the development and implementation of our institution's IABP Mobility Checklist is provided. A retrospective review was conducted for patients with advanced HF who had a femoral IABP to assess safety and feasibility of mobilization. Subjects' demographic, medical, and physical therapy data, as well as safety data, were analyzed. Outcomes: The IABP Mobility Checklist was designed to mirror our institution's practice patterns. It is unique in 2 ways. First, it uses a body systems review screening approach to assess a patient's readiness and tolerance to mobilization. Second, the checklist breaks the screening process into 4 broad but distinct mobility phases to encompass a spectrum of movement. Twenty subjects with advanced HF who had a femoral IABP received 49 physical therapy sessions. The highest level of mobility with a femoral IABP was ambulation (50%). There were no major safety events and 2 minor safety events. Subjects stabilized with termination of mobilization. No additional medical interventions were required. Discussion and Conclusion: The IABP Mobility Checklist was developed and successfully implemented in patients with advanced HF who had a femoral IABP. Through knowledge acquisition, education, and interprofessional collaboration, mobilization in this patient population was safe and feasible.

Digital health coaching to improve patient preparedness for elective lower limb arthroplasty: a quality improvement project

Major surgery carries high risks with comorbidities, frailty and health risk behaviours meaning patients are often unprepared for the physiological insult. Since 2018, the Prepwell programme at South Tees Hospitals...

Mengatasi Kecemasan Pasien Selama Tindakan Pencabutan Gigi: Pendekatan dan Strategi Efektif

Patient anxiety during tooth extraction is a common challenge in dental practice that can affect patient experience and outcome of the procedure. This study aimed to evaluate the effectiveness of approaches and strategies to address patient anxiety during tooth extraction procedures. Through counseling designed to improve patient understanding of the causes of anxiety, relaxation skills, and communication with the dentist, this study measured its impact on patient anxiety levels and preparedness. The study involved patients undergoing tooth extraction procedures, where they attended a counseling session that included information on factors that cause anxiety, breathing relaxation techniques, and communication skills. Data were collected before and after the counseling through a survey that assessed patient knowledge, ability to apply relaxation techniques, self-confidence, and anxiety levels. The results showed a significant increase in patient understanding of the causes of anxiety from 50% to 85%, ability to apply relaxation techniques from 30% to 75%, and self-confidence in facing the procedure from 40% to 80%. In addition, the ability to communicate with the dentist increased from 45% to 78%, and anxiety levels decreased from 70% to 40%. These findings confirm that an educational approach is effective in reducing patient anxiety, increasing preparedness, and improving the experience during tooth extraction. This strategy can be implemented widely to improve the quality of care and patient well-being in dental practice.

Assessing Psychosocial Readiness for Gene Therapy in Sickle Cell Disease: A Consensus Statement

Introduction: Scientific evidence regarding the efficacy and safety of gene therapy for sickle cell disease (SCD) is growing and clinical trials are increasingly available to patients. As a result, clinical trial teams are now challenged with considering the ways in which psychosocial factors may affect patient decisions about pursuing gene therapy and how pre-gene therapy psychosocial functioning may influence long-term patient outcomes. Although data specific to gene therapy for SCD are currently limited, research in other chronic illness populations undergoing major medical procedures (e.g., solid organ and stem cell transplants) suggest that premorbid psychosocial functioning affects decision-making and post-procedure outcomes. Clinical observations support the relevance of considering psychosocial readiness for curative therapies in patients with SCD but there is a lack of guidance regarding how to carry out such evaluations. Therefore, the NHLBI's Cure Sickle Cell Initiative (CureSCi) formed the Patient Readiness and Resilience Working Group to develop consensus recommendations regarding the assessment of psychosocial readiness in the context of gene therapy for SCD. Methods: The NHLBI CureSCi Patient Readiness and Resilience Working Group was formed in September 2020 and consisted of 10 members including mental health clinicians, researchers, and patients and caregivers. The working group met from 2020-2022 to develop best practice recommendations for the assessment of patient readiness and resilience prior to gene therapy for SCD. Recommendations were developed based on available scientific evidence, expert clinical guidance, review of strategic planning documents, and consultation with CureSCi subcommittees and working groups representative of patient, advocate, clinician, and researcher perspectives. A draft of the consensus recommendations was released for public comment in 2022 and final revisions were completed in early 2023. Results: The CureSCi Patient Readiness and Resilience Working Group reached consensus regarding recommended practices for conducting pre-gene therapy assessments of patient readiness in SCD. The working group developed a recommended workflow for assessing patient readiness, including an institutional self-assessment of readiness to support patients' mental health and address psychosocial barriers to care, brief screening of cognitive functioning and health literacy, patient education about clinical trials and gene therapy, assessment of patient readiness and resilience followed by interventions to address areas of concern, and informed consent. Detailed guidance was developed across four primary domains: 1) Effective education delivery; 2) Evaluation of knowledge and understanding; 3) Evaluation of interest and motivation; and 4) Evaluation of psychosocial risk and resilience factors. The working group created a guide to support implementation of pre-gene therapy assessments, which outlines evidence-based strategies for effective patient education, recommended assessment tools, and sample clinical interview questions. Conclusions: As gene therapy for SCD becomes increasingly available to patients, there is a growing need to be prepared to consider readiness and resilience factors that could affect patient well-being before, during, and after treatment. This CureSCi working group developed a set of consensus recommendations regarding the assessment of psychosocial factors in the context of gene therapy for SCD. A thorough guide was developed to aid in implementation of pre-gene therapy assessments across a range of institutional settings. The presentation will review consensus recommendations, describe practical strategies for conducting assessments, and discuss areas for future research.

Assessing Patient Readiness for an Electronic Patient-Reported Outcome-Based Symptom Management Intervention in a Multisite Study.

While the use of electronic patient-reported outcomes (ePROs) in routine clinical practice is increasing, barriers to patient engagement limit adoption. Studies have focused on technology access as a key barrier, yet other characteristics may also confound readiness to use ePROs including patients' confidence in using technology and confidence in asking clinicians questions. To assess readiness to use ePROs, adult patients from six US-based health systems who started a new oncology treatment or underwent a cancer-directed surgery were invited to complete a survey that assessed access to and confidence in the use of technology, ease of asking clinicians questions about health, and symptom management self-efficacy. Multivariable ordinal logistic regression models were fit to assess the association between technology confidence, ease of asking questions, and symptom management self-efficacy. We contacted 3,212 individuals, and 1,043 (33%) responded. The median age was 63 years, 68% were female, and 75% reported having access to patient portals. Over 80% had two or more electronic devices. Most patients reported high technology confidence, higher ease of asking clinicians questions, and high symptom management self-efficacy (n = 692; 66%). Patients with high technology confidence also reported higher ease of asking nurses about their health (adjusted odds ratio [AOR], 4.58 [95% CI, 2.36 to 8.87]; P ≤ .001). Those who reported higher ease of asking nurses questions were more likely to report higher confidence in managing symptoms (AOR, 30.54 [95% CI, 12.91 to 72.30]; P ≤ .001). Patient readiness to use ePROs likely depends on multiple factors, including technology and communication confidence, and symptom management self-efficacy. Future studies should assess interventions to address these factors.

Barriers and Motivators to Weight Loss in People With Obesity.

Obesity has become a global public health challenge with associated health risks. Effective weight-loss interventions are crucial to mitigating these risks and improving overall well-being. However, individuals with obesity often encounter various barriers that hinder their weight loss efforts, while specific motivators can drive them towards successful outcomes. This systematic review aimed to explore the barriers and motivators to weight loss in people with obesity. A literature search was conducted using relevant keywords in electronic databases such as PubMed, Medline, PsycINFO, and Google Scholar. Studies published in peer-reviewed journals during the last 10 years were considered for inclusion. We included studies investigating both barriers and/or motivators to weight loss published in English. The findings showed that motivators for weight loss include health concerns, body satisfaction, family support, normalcy restoration, emotional encouragement, self-determination, and mindful food choices. Motivators involve exercise facilities, balanced diets, and assistance from healthcare providers, peers, friends, or family. Gender influences healthcare providers' influence on weight loss, with women trusting providers more while men lean towards medication options. Healthcare providers play a role in impacting weight loss through discussions and educating patients. Age also influences motivators; adolescents emphasize health, self-esteem, and bullying avoidance, while young women focus on lifestyle influence, resources, and joy. Barriers include insufficient self-control, physical pain, time constraints, dietary restrictions, and a lack of support. Logistical issues, patient readiness, healthcare providers' views, resource scarcity, and social dynamics are also barriers. Dietary barriers involve triggers, emotional states, and limited healthy options. School-aged children with obesity face curriculum challenges and resource scarcity. These findings show the intricate interplay between motivators and barriers, underscoring the multifaceted nature of weight loss in people with obesity. Targeted interventions that address these factors holistically are essential for successful weight management.

Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study.

Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.

Abstract 287: Psychosocial and Functional Status Are Associated With Readiness for Hospital Discharge Among Cardiac Arrest Survivors

Introduction: Long-term cardiac arrest (CA) survivors have recounted feeling unprepared to confront the psychosocial, functional, and cognitive sequelae of CA, but this has not been assessed quantitatively. Hypothesis: Psychosocial, functional, and cognitive status are associated with readiness for discharge post-CA. Methods: We prospectively recruited CA survivors treated by the University of Pittsburgh Post-Cardiac Arrest Service (4/21-9/22) who completed study measures within 72 hours prior to hospital discharge. We used linear regression to examine unadjusted associations between potential covariates (sex, income, arrest location, Charlson Comorbidity Index, time to return of spontaneous circulation, initial rhythm), post-CA sequelae (emotional distress screen via PROMIS Depression and Anxiety Short Forms 4A or PTSD Checklist-5, functional status via modified Rankin Scale, cognitive status via Telephone Interview for Cognitive Status, and social support via ENRICHD Social Support Inventory) and our dependent variable (readiness for discharge assessed via Patient Readiness for Hospital Discharge Scale - Short Form). Covariates significant at p &lt; 0.10 were included in a multivariable regression. Results: We included 110 grossly cognitively intact CA survivors (mean age 59 years, 64% male, 88% non-Hispanic White, 48% low income, 36.4% emotionally distressed, 21.9% functionally dependent, 24.5% cognitively impaired). Emotional distress, functional dependence, and lower social support were associated with lower readiness for discharge (β’s [absolute value]: 0.23-0.31, p &lt; 0.01; R 2 = 0.34) after adjusting for CA location and Charlson Comorbidity Index. Cognitive status, demographic covariates, and other CA clinical characteristics were not associated with readiness for discharge. Conclusion(s): Psychosocial and functional status predict readiness for discharge in this sample of grossly cognitively intact CA survivors. Further research should focus on developing interventions targeted towards these domains prior to hospital discharge.

Communication Openings: A Novel Approach for Serious Illness Communication in Homecare.

Serious illness communication in homecare about hospice and/or palliative care transitions is lacking due to clinical culture. The purpose of the current study was to understand communication openings using COMFORT™, a palliative care communication model used to train nurses. Qualitative, focus group interviews with 31 homecare nurses were conducted. Data were transcribed verbatim and thematically analyzed using NVivo software, followed by hand-sorting. Four themes for communication openings for initiating discussions about potential hospice and/or palliative care transitions were identified: Organizational Openings (homecare appropriateness, eligibility requirements, and staffing); Patient Openings (patient physical decline, psychosocial changes, safety concerns, and denying/stopping care); Caregiver Openings (caregiver physical changes and patient readiness); and Nurse Openings (need for hospice, checking for prognosis understanding, increasing interprofessional care needs, and providing end-of-life care). This study extends the concept of communication openings in the COMFORT model. Further development of communication openings as part of COMFORT communication is needed in educational and intervention research. [Journal of Gerontological Nursing, 49(11), 33-41.].

Revised version of Attitude towards Safe Driving Scale (ASDS-23/SaringSikap-23)

Occupational therapists usually use assessment and screening forms that can identify the problems faced by the person. In the field of driving rehabilitation, the initial assessment is essential, where patient safety and readiness for on-road tests will be determined. Many assessments are available; however, the local instrument was found to be more sensitive and reliable in assessing local drivers. There were a series of publications and reports related to ASDS previously; however, this re-evaluation of the Attitude towards Safe Driving Scale (ASDS-23/SaringSikap-23) is done to report the latest developments in the development of the instrument.

Thematic Analysis of Parental Experiences of Patients' Orthognathic Surgery.

Orthognathic surgery often requires extensive orthodontic preparation and a prolonged postoperative recovery that can be stressful for patients and their families. Parents are a primary source of support for patients; accordingly, a better understanding of the parents' experience of orthognathic surgery can help inform clinical care. Using a prospective cross-sectional qualitative study design, 4 focus groups (2 English and 2 Spanish; mean length 65 min) were held with parents of patients who had completed orthognathic surgery for class II/III malocclusion. Thematic content analysis of the group transcriptions was conducted. Participants were 10 mothers and 3 fathers of 12 children (50% with cleft lip/palate) ages 17 to 23 who completed LeFort I (41.7%), LeFort I with bilateral sagittal split osteotomy (BSSO; 41.7%), or BSSO (16.7%) within the prior 3 to 16 months. Themes fit within a chronological framework: (1) Preparing for Surgery included their larger health context, anticipating surgery, surgery preparation by team and family, and religious faith; (2) Challenges after Surgery consisted of complications, pain, frustration, nutritional challenges, parental anxiety, activity changes, sleep, breathing issues, swelling, and unanticipated aspects of surgery; and (3) Supports after Surgery were nutritional support, appreciation of medical team, postoperative improvements, appearance changes, communicating, supporting patient, and patient coping. Parents also offered advice for families and medical teams. Surgeons and other providers who are part of orthognathic surgical preparation can implement recommendations based on parental experiences to increase patient and family readiness for surgery by providing early education, assisting with advocacy, focusing on nutrition, and supporting coping.