Assessing Parental Discharge Readiness by Using the Ticket to Home Survey Tool

OBJECTIVES Ticket to Home (TTH), a survey tool designed to assess parental comprehension of their child’s hospitalization and postdischarge care needs, allows providers to address knowledge gaps before discharge. Our goal was to evaluate the impact of TTH on parents’ retention of discharge teaching. METHODS In this pilot study, we enrolled a convenience sample of families admitted to pediatric hospital medicine and randomly assigned families on the basis of team assignment. The intervention group received TTH before discharge. The control group received usual care (without TTH survey tool). Both groups were sent a survey 24 to 72 hours postdischarge to assess parental understanding of discharge teaching. A senior-level provider also completed a survey; responses were compared with evaluate parent level of understanding. Descriptive statistics and logistic regression were used for analysis. RESULTS Although 495 parents consented to participate, only 100 completed the necessary surveys (41 intervention and 59 control). Both groups showed high parent-provider concordance regarding reason for admission (92.7% intervention versus 86.4% control; P = .33). The intervention group had significantly higher concordance for return precautions (90.2% vs 58.2%; P < .001), which remained significant when controlling for covariates (odds ratio 6.24, 95% confidence interval 1.78–21.93). Most parents in the intervention group felt sharing TTH responses with their medical team was beneficial (95.0%). CONCLUSIONS Parents who received TTH before discharge were more likely to accurately recall return precautions and valued sharing TTH results with the team. Given that response bias may have affected pilot results, additional studies in which researchers use larger samples with more diverse patient populations is required.

Exploring the Role of Social Support between Discharge Teaching and Readiness for Discharge in Ocular Fundus Disease Patients: A Cross-Sectional Study

Background. This study aims to evaluate the quality of discharge teaching and readiness for discharge of fundus disease patients treated with day surgery and understand the role of social support between them. Methods. This was a cross-sectional descriptive correlational survey. Through convenient sampling, fundus disease patients treated with day surgery from Zhongshan Ophthalmic Center, China, were recruited. Data were collected using demographic and disease-related information, quality of discharge teaching scale, readiness for hospital discharge scale, and social support scale. Results. 255 fundus disease patients treated with day surgery were recruited at last. The mean total score of readiness for discharge, quality of discharge teaching, and social support in patients with fundus disease were 157.91 (SD = 26.68), 122.97 (SD = 21.55), and 36.32 (SD = 7.60), respectively. Participants with stronger social support had better discharge teaching and then had higher readiness for discharge. Social support played a partial mediator role in the relationship between discharge teaching and readiness for discharge. The mediation effect ratio was 5.5%. Conclusions. The quality of discharge teaching and social support among fundus disease patients who underwent day surgery was relatively high, and readiness for discharge was good. Social support is essential for the quality of discharge teaching and the improvement of discharge readiness. Clinical nurses need to provide appropriate guidelines to help patients seek effective support and improve quality of discharge teaching to enhance the readiness for discharge of fundus disease patients treated with day surgery.

One Size Does Not Fit All: Discharge Teaching and Child Challenging Behaviors

This study compares quality of discharge teaching and care coordination for parents of children with challenging behaviors participating in a nursing implementation project, which used an interactive iPad application, to usual discharge care. Unlike parents in the larger quasi-experimental longitudinal project, parents of children with challenging behaviors receiving the discharge teaching application (n = 14) reported lower mean scores on the quality of discharge teaching scale–delivery subscale ( M = 8.2, SD = 3.1) than parents receiving usual care (n = 11) ( M = 9.6, SD = 4.7) and lower scores on the Care Transition Measure ( M = 2.44, SD = 1.09) than parents receiving usual care ( M = 3.02, SD = 0.37), with moderate to large effects (0.554–0.775). The discharge teaching approach was less effective with this subset, suggesting other approaches might be considered for this group of parents. Further study with a larger sample specific to parents of children with challenging behaviors is needed to assess their unique needs and to optimize their discharge experience.

Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol

Background Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions. Methods This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses’ teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients’ activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission. Discussion The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention. Trial registration The trial is registered at ClinicalTrials.gov (ID: NCT04253665) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).

Effectiveness of Nurse-Driven Discharge Teaching Using Mobile Application for Home-Based Health Care Practices among Postoperative Neurosurgical Patients or Caregivers in a Tertiary Care Hospital, New Delhi: A Randomized Control Study

Introduction Considering the increased access to mobile use even in the remote areas, it may be feasible to utilize mobile application (App)-based education among neurosurgical patients and caregivers for home-based care. Objective This study was aimed to assess the effectiveness of nurse-driven discharge teaching using mobile App for home-based health care practices in terms of discharge advice compliances, revisits, and satisfaction among postoperative neurosurgical patients. Materials and Methods This randomized control trial was conducted among 100 (50 in each arm) postoperative neurosurgical patients admitted to Neurosurgery department, All India Institute of Medical Sciences (AIIMS), New Delhi. The experimental group received mobile App–based discharge teaching additional to the routine paper-based discharge teaching received by the control group. Data were collected at baseline, during first (within 30th day) and second (within 60th day) routine follow-up visits using adherence to refills and medications scale (ARMS) questionnaire (medication compliance), self-developed structured questionnaires (lifestyle practices like tracheostomy tube (TT) catheter care, exercises and diet changes, revisits, and satisfaction) and computerized log record from App. Data were analyzed using descriptive and inferential statistics. Results The demographic and clinical profiles of both groups were comparable. There was no statistically significant difference in medication compliance between the experimental group and control group (p = 0.35 and 0.53) in first and second posttests, respectively. The level of confidence to perform lifestyle practices was high among experimental group. The subgroup analysis showed that patients in experimental arm were more compliant to medications as compared with control group (p = 0.001). Both the groups were comparable in terms of revisits (p = 0.26). However, the overall satisfaction of experimental group was reported to be highly using mobile App based teaching than control group with routine paper-based discharge teaching (p = 0.001). Conclusion Nurse-driven discharge teaching using mobile App is an effective method for neurosurgical patients to adhere to home-based discharge teachings. Use of technology like mobile Apps in vernacular language can bridge the gap for improving home-based care and follow-up among patients in resource constrained settings.

Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery

Background To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors. Methods A cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected. Results According to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05). Conclusion The level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.

Implementation of an enhanced discharge teaching protocol to reduce 30-day hospital readmissions in adults diagnosed with Sickle Cell Disease

Background and objectives: Sickle Cell Disease is a painful genetic disorder characterized by abnormal hemoglobin that affects 1-in-365 African American births. Individuals with Sickle Cell Disease often experience frequent hospitalizations, resulting in 30-day readmission rates 2.5 times higher than those without Sickle Cell Disease. Discharge education programs have shown to improve 30-day readmissions and improve health outcomes.Methods: This advanced practice nurse-led initiative incorporated components of the Re-Engineered Discharge (Project RED) protocol, which included patient and medication education, specific discharge teaching, and post-discharge follow-up phone calls over a 12-week period. A pre/posttest design was used to evaluate 30-day readmission. Analyses included descriptive statistics and Fisher’s exact test.Results: Of the (N = 10) participants, eight (80%) were female, with a mean age of 31.08 (± 4.33) and all were African Americans. Although not statistically significant, there was a 48% reduction in 30-day readmissions rates between the pre/post intervention periods.Conclusions: The utilization of an enhanced discharge teaching protocol is a practical solution to increase patients’ readiness for discharge and to reduce 30-day readmission rates. Project RED discharge teaching protocol is an effective strategy for nurses to employ to improve patient outcomes and quality of care for persons with Sickle Cell Disease.