Clinical Nurse Specialist

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Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

WEISS, MARIANNE E. DNSc, RN; PIACENTINE, LINDA B. MS, RN, ACNP; LOKKEN, LISA MSN, RNC; ANCONA, JANICE MSN, RN; ARCHER, JOANNE MSN, APRN, BC-ADM; GRESSER, SUSAN APRN, BC, APNP; HOLMES, SUE BAIRD MS, RN, ONC; TOMAN, SALLY MSN, RN, CWOCN, CNS; TOY, ANNE MS, RN; VEGA-STROMBERG, TERI MSN, RN, ACHPN, AOCN

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Abstract

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients' perceptions of their readiness for hospital discharge.

Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables.

Setting: Midwestern tertiary medical center.

Sample: 147 adult medical-surgical patients.

Methods: 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.

Findings: 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.

Conclusions: 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.

Implications for Practice: 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.

© 2007 Lippincott Williams & Wilkins, Inc.

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